{
  "abstract": "Background: Autoimmune encephalitis (AE) is an immune-mediated inflammatory disorder of the central nervous system associated with substantial morbidity. Acute-phase immunotherapy is crucial for improving outcomes, yet the comparative efficacy and safety of available regimens remain unclear. We therefore performed a Bayesian network meta-analysis to compare acute-phase immunotherapeutic strategies for AE.\n\nMethods: PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to October 2025 for studies evaluating acute-phase immunotherapy in AE. A Bayesian network meta-analysis was conducted. The primary outcome was change in the modified Rankin Scale (mRS) after treatment; adverse events were secondary outcomes. Effects were expressed as mean differences (MD) and risk ratios (RRs) with 95% credible intervals (CrIs). The surface under the cumulative ranking curve (SUCRA) was used to rank interventions.\n\nResults: Eleven studies (1,359 patients) were included, evaluating seven strategies: intravenous methylprednisolone (IVMP), intravenous immunoglobulin (IVIG), IVMP+IVIG, IVMP+plasma exchange (PE), IVMP+IVIG+PE, IVMP+immunoadsorption (IA), and IVMP+efgartigimod (EFG). For efficacy, IVMP+EFG ranked highest in mRS improvement among the included regimens (MD = −0.99, 95% CrI −1.30 to −0.68; SUCRA = 95%), followed by IVMP+IA (MD = −0.87; SUCRA = 88%). IVMP+PE ranked lowest (MD = 0.32; SUCRA = 0.2%). For safety, IVIG monotherapy had the lowest adverse-event risk (RR = 0.51, 95% CrI 0.24 to 0.97), whereas IVMP+PE had the highest risk (RR = 3.10, 95% CrI 0.92 to 9.60).\n\nConclusion: Acute-phase immunotherapy for AE should be individualized by disease severity and antibody subtype. Consistent directional findings were observed in the anti-NMDAR subgroup and, separately, in the subgroup with baseline mRS ≥3. IVMP+EFG and IVMP+IA ranked favorably for short-term functional improvement, although the evidence was based mainly on observational studies and small sample sizes. IVIG remained a reasonable option given its favorable safety profile.\n\nSystematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251085606 , identifier CRD420251085606.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurology, Affiliated Hospital of Hebei University"
  ],
  "article_type": "systematic review",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yan Deng"
    },
    {
      "affs": [
        0
      ],
      "name": "Yun Cai"
    },
    {
      "affs": [
        0
      ],
      "name": "Xin Yang"
    },
    {
      "affs": [
        0
      ],
      "name": "Lihua Xu"
    },
    {
      "affs": [
        0
      ],
      "name": "Yanan Chen"
    },
    {
      "affs": [
        0
      ],
      "name": "Na Liu"
    },
    {
      "affs": [
        0
      ],
      "name": "Weiying Di"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7y492qrn49v5g.bib",
  "cited_by": 0,
  "doi": "10.3389/fimmu.2026.1807436",
  "fulltext_url": "https://europepmc.org/articles/PMC13683221",
  "id": "7y492qrn49v5g",
  "issns": [
    "1664-3224"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1807436/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2728|Autoimmune Neurological Disorders and Treatments"
    ]
  ],
  "openalex": "W7220838076",
  "pdf_url": "https://europepmc.org/articles/PMC13683221?pdf=render",
  "pmcid": "PMC13683221",
  "pmid": "42908834",
  "published": "2026-10-07",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/7y492qrn49v5g.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:15Z",
      "native_id": "10.3389/fimmu.2026.1807436",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1807436/full"
    },
    {
      "first_seen": "2026-10-30T12:20:14Z",
      "native_id": "MED:42908834",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42908834"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2728|Autoimmune Neurological Disorders and Treatments",
      "subfield": "neurology"
    }
  ],
  "title": "Efficacy and safety of acute-phase immunotherapy for adult autoimmune encephalitis: a systematic review and network meta-analysis",
  "title_text": "Efficacy and safety of acute-phase immunotherapy for adult autoimmune encephalitis: a systematic review and network meta-analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:14Z",
  "url": "https://research.draconitic.com/paper/7y492qrn49v5g",
  "venue": "Frontiers in Immunology",
  "versions": []
}