Immunotherapy for autoimmune encephalitis

Autoimmune encephalitis (AE) is increasingly recognized as a cause of brain disorders that greatly benefit from immunotherapy. Starting treatment quickly and increasing the use of immunotherapy can lead to better results for AE patients. Currently, there are standardized treatment guidelines for treating AE. First-line therapy includes intravenous corticosteroids, plasma exchange, and intravenous immunoglobulin. Second-line therapy involves rituximab, cyclophosphamide, mycophenolate mofetil, and azathioprine. Third-line therapy uses agents that deplete plasma cells (bortezomib, daratumumab, and obinutuzumab), drugs that modulate cytokines (tocilizumab, anakinra, tofacitinib, and interleukin-2), and treatments that target intrathecal immune cells (intrathecal methotrexate). This review aims to summarize the immunotherapeutic strategies available for treating AE and provide an update on refractory AE.