Journal article
An updated, comprehensive meta-analysis of the treatment of anti-NMDAR encephalitis: Analysis, equipoise, and the urgent need for evidence over anecdote
Journal of neuroimmunology, Vol.405, 578651
08/15/2025
DOI: 10.1016/j.jneuroim.2025.578651
PMID: 40472799
Abstract
There are no FDA-approved treatments for anti-N-methyl-d-aspartate receptor encephalitis (NMDARE), and no prospective, multicenter clinical trials have been completed to provide evidence for management of this disease. We evaluated changes in treatment strategies and outcomes since the previous comprehensive review in 2019.
A systematic literature review was conducted in PubMed capturing manuscripts published from January 2019 through March 2024. Demographic and clinical data were extracted from articles containing individual immunotherapy data in NMDARE and were compared to a previously published literature review. Studies with ≥10 cases, ≥6 months follow-up, and outcomes reported as favorable (modified Rankin Scale [mRS] 0-2) and poor (mRS 3-5 or 3-6), were grouped and summarized by diagnosis period.
Among 649 patients from 321 articles, first- (from 91.3 % to 98.3 %, p < 0.001) and second-line (from 31.8 % to 42.5 %, p < 0.001) immunotherapy use has increased. The proportion of patients receiving immunotherapy within 30 days of symptom onset increased from 50.1 % to 72.5 % (p < 0.001). Favorable outcome (mRS 0-2) increased from 71.5 % to 76.7 % (p = 0.024), while mortality (6.3 % to 6.9 %, p = 0.714) and relapse rates (12.6 % vs. 13.2 %, p = 0.789) remained unchanged. Data from larger cohort studies of patients diagnosed with NMDARE after 2013 have reported wide variability in the proportion of patients achieving a favorable outcome at final follow-up, ranging from 56 % to 93 %, depending on the institution and follow-up duration.
Since 2019, more patients have been treated early with first- and second-line immunotherapies. Functional outcomes have shown modest improvements, whereas mortality and relapse rates have remained unchanged.
Details
- Title: Subtitle
- An updated, comprehensive meta-analysis of the treatment of anti-NMDAR encephalitis: Analysis, equipoise, and the urgent need for evidence over anecdote
- Creators
- Yoji Hoshina - University of UtahTammy L Smith - University of UtahAlen Delic Mstat - University of UtahKa-Ho Wong - University of UtahLisa K Peterson - University of UtahAnastasia Zekeridou - Mayo ClinicAlbert Aboseif - Mayo ClinicChristopher Coffey - University of IowaMelissa A Wright - University of UtahBrenda Banwell - Johns Hopkins UniversityAnnalisa Dialino-Felix - AmgenSusan Flavin - AmgenLisa Dill - AmgenMaarten J Titulaer - Erasmus MCGregory S Day - Mayo Clinic in FloridaStacey L Clardy - University of Utah
- Resource Type
- Journal article
- Publication Details
- Journal of neuroimmunology, Vol.405, 578651
- Publisher
- ELSEVIER
- DOI
- 10.1016/j.jneuroim.2025.578651
- PMID
- 40472799
- ISSN
- 0165-5728
- eISSN
- 1872-8421
- Language
- English
- Electronic publication date
- 05/27/2025
- Date published
- 08/15/2025
- Academic Unit
- Biostatistics
- Record Identifier
- 9984827335902771
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