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Efficacy and safety of rituximab in autoimmune encephalitis: A meta‐analysis
Author(s) -
Nepal Gaurav,
Shing Yow K.,
Yadav Jayant K.,
Rehrig Jessica H.,
Ojha Rajeev,
Huang Dong Y,
Gajurel Bikram P.
Publication year - 2020
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.13291
Subject(s) - rituximab , medicine , meta analysis , disease , cd20 , immunology , oncology , lymphoma
Background Autoimmune encephalitis (AE) is a rare but debilitating neurological disease where the body develops antibodies against neuronal cell surface/synaptic proteins. Rituximab is an anti‐CD20 chimeric monoclonal antibody which shows promise in AE treatment observational studies. To our knowledge, there has been no previous meta‐analysis providing robust evidence on the effectiveness and safety of rituximab as second‐line therapy for the treatment for AE. Methods This study was conducted according to the PRISMA (Preferred Reporting Items for Systematic review and Meta‐Analysis) statement. Investigators independently searched PubMed, Web of Science, Google Scholar, WANFANG, CNKI, and J‐STAGE for studies. Meta‐analysis via representative forest plots was conducted for good functional outcome (mRS ≤ 2), proportion of relapse, and mRS score change pre‐ and post‐treatment. Results Good functional outcome at last follow‐up following rituximab therapy occurred in 72.2% of patients (95% CI: 66.3%‐77.4%). Mean mRS score decreased by 2.67 (95% CI: 2.04‐3.3; P < .001). Relapses following the rituximab therapy occurred in only 14.2% of patients (95% CI: 9.5%‐20.8%). Infusion related reactions, pneumonia, and severe sepsis were seen in 29 (15.7%), 11 (6.0%), and two patients (1.1%), respectively. The efficacy and side effect profile of rituximab are comparable to outcomes seen in rituximab use in other autoimmune and inflammatory CNS disease. Conclusion Our meta‐analysis showed that rituximab is an effective second‐line agent for AE with an acceptable toxicity profile.