Efficacy of rituximab as second-line therapy for autoimmune encephalitis: A systematic review and meta-analysis
Background: Approximately 20%–50 % of individuals with autoimmune encephalitis (AE) demonstrate suboptimal responses to first-line therapies, leading to persistent neurological deficits and the need for second-line interventions. Although rituximab has shown potential as an alternative treatment in...
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Elsevier
2025-01-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844025001276 |
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| author | Lin-ming Zhang Xuan-lin Xing Bing-ran Zhang Qiu-juan Zhang Yan-lin Zhu Shu-ji Gao Ming-wei Liu |
| author_facet | Lin-ming Zhang Xuan-lin Xing Bing-ran Zhang Qiu-juan Zhang Yan-lin Zhu Shu-ji Gao Ming-wei Liu |
| author_sort | Lin-ming Zhang |
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| description | Background: Approximately 20%–50 % of individuals with autoimmune encephalitis (AE) demonstrate suboptimal responses to first-line therapies, leading to persistent neurological deficits and the need for second-line interventions. Although rituximab has shown potential as an alternative treatment in AE, the existing evidence remains insufficient. This study systematically evaluated and meta-analyzed the efficacy of rituximab in AE patients who either failed or exhibited inadequate responses to first-line treatments, aiming to refine and optimize therapeutic strategies for AE. Methods: A comprehensive search of PubMed, Embase, and the Cochrane Library databases was conducted, covering studies published up to June 10, 2024. In addition, manual cross-referencing of relevant studies was performed using both subject-specific and free-text terms such as “Rituximab,” “Rituxan,” “Mabthera,” “RTX,” “Mab,” “Ma,” “AE,” “encephalitis,” “Anti-NMDAR encephalitis,” and “autoimmune encephalitis.” Data on rituximab's efficacy as a second-line therapy in AE were independently screened and extracted by two researchers. Statistical analyses were conducted using R4.2.1 software to assess the pooled outcomes of the included studies. Results: Analysis of 14 studies involving 277 AE cases revealed an 80 % favorable prognosis rate (0.72–0.89) for rituximab, with superior efficacy in patients under 18 years compared to those over 18 (I2 = 65.9 %, 38.7%–81.0 %; p < 0.01). The prognosis rate for patients under 18 was 0.85 (0.76–0.93), while for those over 18, it was 0.72 (0.56–0.88). Furthermore, a disease duration of ≤180 days correlated with a better prognosis than durations exceeding 180 days, with rates of 0.82 (0.69–0.94) and 0.74 (0.61–0.87), respectively. Conclusion: Rituximab demonstrates an 80 % favorable prognosis rate in AE cases unresponsive to first-line treatments, particularly in patients under 18 or those with disease duration ≤180 days. |
| format | Article |
| id | doaj-art-0287254afe964f6f8a4493137ca89962 |
| institution | Kabale University |
| issn | 2405-8440 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj-art-0287254afe964f6f8a4493137ca899622025-02-02T05:28:04ZengElsevierHeliyon2405-84402025-01-01112e41747Efficacy of rituximab as second-line therapy for autoimmune encephalitis: A systematic review and meta-analysisLin-ming Zhang0Xuan-lin Xing1Bing-ran Zhang2Qiu-juan Zhang3Yan-lin Zhu4Shu-ji Gao5Ming-wei Liu6Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, ChinaDepartment of Emergency, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, ChinaDepartment of Emergency, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, ChinaDepartment of Emergency, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, ChinaDepartment of Emergency, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, ChinaDepartment of Emergency, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, ChinaDepartment of Emergency, Dali Bai Autonomous Prefecture People's Hospital, Dali, Yunnan, 671000, China; Corresponding author. Department of Emergency, People's Hospital of Dali Bai Autonomous Prefecture, 35 Renmin South Road, Xiaguan street, Dali, 671000, China.Background: Approximately 20%–50 % of individuals with autoimmune encephalitis (AE) demonstrate suboptimal responses to first-line therapies, leading to persistent neurological deficits and the need for second-line interventions. Although rituximab has shown potential as an alternative treatment in AE, the existing evidence remains insufficient. This study systematically evaluated and meta-analyzed the efficacy of rituximab in AE patients who either failed or exhibited inadequate responses to first-line treatments, aiming to refine and optimize therapeutic strategies for AE. Methods: A comprehensive search of PubMed, Embase, and the Cochrane Library databases was conducted, covering studies published up to June 10, 2024. In addition, manual cross-referencing of relevant studies was performed using both subject-specific and free-text terms such as “Rituximab,” “Rituxan,” “Mabthera,” “RTX,” “Mab,” “Ma,” “AE,” “encephalitis,” “Anti-NMDAR encephalitis,” and “autoimmune encephalitis.” Data on rituximab's efficacy as a second-line therapy in AE were independently screened and extracted by two researchers. Statistical analyses were conducted using R4.2.1 software to assess the pooled outcomes of the included studies. Results: Analysis of 14 studies involving 277 AE cases revealed an 80 % favorable prognosis rate (0.72–0.89) for rituximab, with superior efficacy in patients under 18 years compared to those over 18 (I2 = 65.9 %, 38.7%–81.0 %; p < 0.01). The prognosis rate for patients under 18 was 0.85 (0.76–0.93), while for those over 18, it was 0.72 (0.56–0.88). Furthermore, a disease duration of ≤180 days correlated with a better prognosis than durations exceeding 180 days, with rates of 0.82 (0.69–0.94) and 0.74 (0.61–0.87), respectively. Conclusion: Rituximab demonstrates an 80 % favorable prognosis rate in AE cases unresponsive to first-line treatments, particularly in patients under 18 or those with disease duration ≤180 days.http://www.sciencedirect.com/science/article/pii/S2405844025001276RituximabAutoimmune encephalitisTreatment effectsN-methyl-D-aspartate receptorMeta-analysis |
| spellingShingle | Lin-ming Zhang Xuan-lin Xing Bing-ran Zhang Qiu-juan Zhang Yan-lin Zhu Shu-ji Gao Ming-wei Liu Efficacy of rituximab as second-line therapy for autoimmune encephalitis: A systematic review and meta-analysis Heliyon Rituximab Autoimmune encephalitis Treatment effects N-methyl-D-aspartate receptor Meta-analysis |
| title | Efficacy of rituximab as second-line therapy for autoimmune encephalitis: A systematic review and meta-analysis |
| title_full | Efficacy of rituximab as second-line therapy for autoimmune encephalitis: A systematic review and meta-analysis |
| title_fullStr | Efficacy of rituximab as second-line therapy for autoimmune encephalitis: A systematic review and meta-analysis |
| title_full_unstemmed | Efficacy of rituximab as second-line therapy for autoimmune encephalitis: A systematic review and meta-analysis |
| title_short | Efficacy of rituximab as second-line therapy for autoimmune encephalitis: A systematic review and meta-analysis |
| title_sort | efficacy of rituximab as second line therapy for autoimmune encephalitis a systematic review and meta analysis |
| topic | Rituximab Autoimmune encephalitis Treatment effects N-methyl-D-aspartate receptor Meta-analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2405844025001276 |
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