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在抗NMDA受体脑炎 (LEARN) 中长期维持mycophenolate mofetil:多中心,开放标签,盲目的终点,随机对照试验

Xue Gong¹, Yue Liu¹, Yaru Ma¹

¹Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.

Journal of neurology, neurosurgery, and psychiatry

|February 27, 2025

概括

在抗N-甲基-D-酸盐受体脑炎 (NMDARE) 患者中,mycophenolate mofetil (MMF) 显著降低了复发率. 这种辅助疗法耐受性良好,为NMDARE提供了一个有前途的维持策略.

科学领域:

神经学神经学
免疫学免疫学免疫学
临床试验临床试验

背景情况:

抗N-甲基-D-酸盐受体脑炎 (NMDARE) 是一种严重的自身免疫神经系统疾病,与显著的发病率和死亡率有关.
目前对NMDARE的治疗面临着患者复发的挑战,需要开发有效的长期维持疗法.

研究的目的:

评估mycophenolate mofetil (MMF) 作为新诊断的NMDARE患者的长期辅助疗法的疗效和安全性.
评估MMF对复发率,治疗反应,认知功能和NMDARE管理中的不良事件的影响.

主要方法:

在中国的四个学术中心进行了前性,随机化,开放性试验.
100名14岁以上的急性NMDARE患者,在发病2周内接受治疗,mRS得分≥2,随机分配给接受标准治疗或不接受MMF24个月.
主要结局包括复发率和复发时间;次要结局包括认知缺陷,治疗反应和不良事件.

主要成果:

接受MMF治疗的患者出现明显较低的复发率 (5.9%对26.5%,p=0.006) 和改善的治疗反应 (84.3%对65.3%,p=0.03).
MMF组报告说,疲劳,认知障碍,抑郁和发作减少,在12个月和24个月的长期功能预后没有显著差异.
与MMF相关的不良事件为轻度至中度,没有报告死亡或过敏反应.

结论:

在NMDARE中长期辅助的MMF治疗显著降低了复发的风险.
MMF表现出良好的耐受性,是NMDARE患者24个月以上的可行的维持治疗选择.
该研究提供了II类证据,支持货币市场基金在NMDARE管理中的作用.

关键词:

自免疫性脑炎 (AUTOIMMUNE ENCEPHALITIS) 是一种自免疫性脑炎.

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