Protein A immunoadsorption for the treatment of refractory anti-N-methyl-d-aspartate receptor encephalitis : A single-center prospective study
Copyright © 2021. Published by Elsevier B.V..
OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of protein A immunoadsorption (IA) for anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis resistant to intravenous methylprednisolone (IVMP) and intravenous immunoglobulin (IVIG).
METHODS: We prospectively evaluated patients with refractory anti-NMDAR encephalitis, treated with protein A IA. Demographic data, clinical characteristics, modified Rankin Score (mRS), and anti-NMDAR antibodies were documented before and after IA and at follow-up. Clinical improvement was defined as a decrease of mRS ≥1. Adverse events were recorded throughout the study.
RESULTS: Ten patients with mRS ≥3 were enrolled and treated with protein A IA; treatment was performed for an average of 5.2 times per patient. Among the nine patients with positive serum anti-NMDAR, the titer decreased in seven patients, of which two became negative. The cerebrospinal fluid (CSF) anti-NMDAR titer decreased in all patients, and one became negative. Anti-NMDAR levels were tested in two patients at follow-up and found to have declined continuously. All patients exhibited clinical improvement with a mRS decline ≥1 after IA treatment (median mRS: 5.0 [range, 3.0-5.0] vs. 4.0 [range, 2.0-4.0], p = 0.014), and the median mRS decreased to 1.0 (range, 0-3.0) at follow-up. After IA, all patients exhibited accelerated recovery. No adverse events were observed during IA treatment.
CONCLUSION: Protein A IA may be effective for treating IVMP/IVIG-resistant anti-NMDAR encephalitis and well tolerated. It is necessary to initiate larger-scale prospective controlled studies to validate the efficacy and safety of protein A IA in anti-NMDAR encephalitis.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:428 |
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| Enthalten in: |
Journal of the neurological sciences - 428(2021) vom: 15. Sept., Seite 117568 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Zhang, Bingjun [VerfasserIn] |
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| Links: |
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| Themen: |
Anti-NMDAR encephalitis |
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| Anmerkungen: |
Date Completed 05.10.2021 Date Revised 05.10.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jns.2021.117568 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM327928522 |
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| 100 | 1 | |a Zhang, Bingjun |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Protein A immunoadsorption for the treatment of refractory anti-N-methyl-d-aspartate receptor encephalitis |b A single-center prospective study |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Completed 05.10.2021 | ||
| 500 | |a Date Revised 05.10.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021. Published by Elsevier B.V. | ||
| 520 | |a OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of protein A immunoadsorption (IA) for anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis resistant to intravenous methylprednisolone (IVMP) and intravenous immunoglobulin (IVIG) | ||
| 520 | |a METHODS: We prospectively evaluated patients with refractory anti-NMDAR encephalitis, treated with protein A IA. Demographic data, clinical characteristics, modified Rankin Score (mRS), and anti-NMDAR antibodies were documented before and after IA and at follow-up. Clinical improvement was defined as a decrease of mRS ≥1. Adverse events were recorded throughout the study | ||
| 520 | |a RESULTS: Ten patients with mRS ≥3 were enrolled and treated with protein A IA; treatment was performed for an average of 5.2 times per patient. Among the nine patients with positive serum anti-NMDAR, the titer decreased in seven patients, of which two became negative. The cerebrospinal fluid (CSF) anti-NMDAR titer decreased in all patients, and one became negative. Anti-NMDAR levels were tested in two patients at follow-up and found to have declined continuously. All patients exhibited clinical improvement with a mRS decline ≥1 after IA treatment (median mRS: 5.0 [range, 3.0-5.0] vs. 4.0 [range, 2.0-4.0], p = 0.014), and the median mRS decreased to 1.0 (range, 0-3.0) at follow-up. After IA, all patients exhibited accelerated recovery. No adverse events were observed during IA treatment | ||
| 520 | |a CONCLUSION: Protein A IA may be effective for treating IVMP/IVIG-resistant anti-NMDAR encephalitis and well tolerated. It is necessary to initiate larger-scale prospective controlled studies to validate the efficacy and safety of protein A IA in anti-NMDAR encephalitis | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Anti-NMDAR encephalitis | |
| 650 | 4 | |a Protein A immunoadsorption | |
| 650 | 4 | |a Refractory | |
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| 650 | 7 | |a Immunoglobulins, Intravenous |2 NLM | |
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| 700 | 1 | |a Yu, Dafan |e verfasserin |4 aut | |
| 700 | 1 | |a Zhu, Qiang |e verfasserin |4 aut | |
| 700 | 1 | |a Ruan, Hengfang |e verfasserin |4 aut | |
| 700 | 1 | |a Yu, Boguang |e verfasserin |4 aut | |
| 700 | 1 | |a Cui, Chunping |e verfasserin |4 aut | |
| 700 | 1 | |a Yang, Yu |e verfasserin |4 aut | |
| 700 | 1 | |a Qiu, Wei |e verfasserin |4 aut | |
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