Efficacy and Safety of Rituximab in Chinese Children With Refractory Anti-NMDAR Encephalitis.

Abstract

Purpose: To assess the efficacy and safety of rituximab treatment as second-line immunotherapy in pediatric cases of anti-NMDA receptor (NMDAR) encephalitis. Methods: We retrospectively recruited 8 patients with anti-NMDAR encephalitis who were treated with rituximab as second-line immunotherapy. We evaluated the clinical features, laboratory examination results and treatment protocols of the Chinese children and defined good outcomes based on the modified Rankin scale (mRS) score (0-2) at the last follow-up. Results: A total of eight pediatric patients (median age 6.7 years; four female) with refractory anti-NMDAR encephalitis were recruited to the study. Rituximab was given after a median duration of disease of 57 days (range 50.5-113.75 days). The use of rituximab led to a significant reduction in the mRS and CD19+ B-cells compared to before rituximab infusion (P < 0.05). Five patients (62.5%) had a good outcome (mRS ≤ 2) including four patients (50%) who showed complete recovery (mRS = 0) at the last follow-up. Transient infusion adverse events were recorded in 2 patients (25%). Two patients (25%) had severe infectious adverse events (AEs) and two patients with grade 5 (death). None of the patients developed progressive multifocal leukoencephalopathy (PML). Conclusion: Our study provides evidence that rituximab can efficiently improve the clinical symptoms of anti-NMDAR encephalitis in children. However, due to the risk of adverse infections, rituximab should be restricted in pediatric patients with high rates of mortality and disability.

• Authors: Xiangjun Dou, Dongjing Li, Yan Wu, Zhijing Wang, Le Yang, Nan Ma, Dong Wang, Xia Li
• Journal: Frontiers in neurology (Front Neurol) Vol. 11 Pg. 606923 ( 2020) ISSN: 1664-2295 [Print] Switzerland
• PMID: 33381080 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Dou, Li, Wu, Wang, Yang, Ma, Wang and Li.