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Background and purpose <p>Rituximab is a widely used second-line immune drug for the treatment of anti-NMDAR encephalitis in patients who fail to improve approximately 2 weeks after the initiation of first-line therapies (corticosteroids, intravenous immunoglobulin, plasma exchange). The aim of this study was to investigate the efficacy and safety of low-dose rituximab in the treatment of autoimmune encephalitis in children.</p> Methods <p>This case series included 6 hospitalized children without tumors with anti-NMDAR encephalitis from January 2018 to December 2020. These children were treated with low-dose rituximab (100&#xa0;mg, once weekly, according to peripheral blood CD19 + B-cell levels, 3–4 cycles, until CD19 + B cells in peripheral blood were cleared) approximately 2 weeks after the initiation of 2 or more first-line immunotherapies.</p> Results <p>After 3–4 cycles of low-dose rituximab (100&#xa0;mg) treatment, the mRS score and CD19 + B-cell count decreased significantly, and the patients maintained stable neurological function (mRS ≤ 2). No adverse events resulting from infusion or other adverse reactions occurred in any patient.</p> Conclusion <p>In children with autoimmune encephalitis without tumors for whom first-line immunotherapy is ineffective, low-dose rituximab effectively reduces peripheral blood CD19 + B-cell counts, improves the clinical symptoms of patients and reduces hospitalization expenses. RCTs with sufficient sample sizes are needed to firmly establish the value of low-dose rituximab therapy for treating anti-NMDAR encephalitis in children.</p>

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Low-dose rituximab for the treatment of anti-NMDAR encephalitis in children: a case series study

  • 期刊论文

  • 发表日期：

    2025年5月15日

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  • Haiyan Wu,
  • Fenfen Xu,
  • Yuan Chen,
  • Shanshan Ding,
  • Wei Li,
  • Qiuyue Li,
  • Na Chen,
  • Lin Tang

摘要

Background and purpose

Rituximab is a widely used second-line immune drug for the treatment of anti-NMDAR encephalitis in patients who fail to improve approximately 2 weeks after the initiation of first-line therapies (corticosteroids, intravenous immunoglobulin, plasma exchange). The aim of this study was to investigate the efficacy and safety of low-dose rituximab in the treatment of autoimmune encephalitis in children.

Methods

This case series included 6 hospitalized children without tumors with anti-NMDAR encephalitis from January 2018 to December 2020. These children were treated with low-dose rituximab (100 mg, once weekly, according to peripheral blood CD19 + B-cell levels, 3–4 cycles, until CD19 + B cells in peripheral blood were cleared) approximately 2 weeks after the initiation of 2 or more first-line immunotherapies.

Results

After 3–4 cycles of low-dose rituximab (100 mg) treatment, the mRS score and CD19 + B-cell count decreased significantly, and the patients maintained stable neurological function (mRS ≤ 2). No adverse events resulting from infusion or other adverse reactions occurred in any patient.

Conclusion

In children with autoimmune encephalitis without tumors for whom first-line immunotherapy is ineffective, low-dose rituximab effectively reduces peripheral blood CD19 + B-cell counts, improves the clinical symptoms of patients and reduces hospitalization expenses. RCTs with sufficient sample sizes are needed to firmly establish the value of low-dose rituximab therapy for treating anti-NMDAR encephalitis in children.