Different oral prednisone tapering regimens for the treatment of anti-LGI1 encephalitis: A multicenter cohort study

Intravenous methylprednisolone (IVMP) is the most commonly used first-line treatment for acute anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis. However, there is currently no consensus regarding the optimal oral prednisone tapering (OPT) regimen following IVMP therapy for anti-LGI1 encephalitis. We aim to compare the efficacy and safety of different OPT courses in the treatment of anti-LGI1 encephalitis.

The CHASE study is a multicenter prospective observational cohort study. As part of this study, patients with anti-LGI1 encephalitis were enrolled between October 2011 and December 2024. Patients were grouped based on oral prednisone tapering course: ≤ 3 months (Group ≤ 3 mo), and > 3 months (Group > 3 mo). Propensity score matching (PSM) was performed to control for major confounding factors. Kaplan-Meier plots were used to analyze time to relapse and time to total recovery within 2 years. Subgroup and sensitivity analyses were performed to validate results.

We included 54 patients with anti-LGI1 encephalitis (mean age 48.8 ± 16.2 years; 70.4% female). No significant differences in 2-year relapse-free survival were observed between groups before and after PSM. Similarly, no significant differences were found in mRS score, CASE score, cognitive performance, responder rates, or total recovery. Adverse events were more frequent in Group > 3 mo than in Group ≤ 3 mo (21 [84.0%] vs 16 [55.2%], P = 0.023), but this difference was not statistically significant after PSM.

Our preliminary observational findings suggest that longer prednisone tapering was not associated with significant reductions in relapse or improvements in global functional outcomes. Notably, multivariable linear regression showed prolonged tapering was associated with lower long-term CASE scores, suggesting reduced long-term disease burden. Given the limited sample size and relapse events, clinically meaningful differences between tapering strategies cannot be excluded. These findings require confirmation in adequately powered randomized trials.