Efficacy and safety of acute-phase immunotherapy for adult autoimmune encephalitis: a systematic review and network meta-analysis
- 1Department of Neurology, Affiliated Hospital of Hebei University
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.
Methods: 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.
Results: 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).
Conclusion: 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.
Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251085606 , identifier CRD420251085606.
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BibTeX
@article{deng2026efficacy,
title = {{Efficacy and safety of acute-phase immunotherapy for adult autoimmune encephalitis: a systematic review and network meta-analysis}},
author = {Yan Deng and Yun Cai and Xin Yang and Lihua Xu and Yanan Chen and Na Liu and Weiying Di},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1807436},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1807436/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Efficacy and safety of acute-phase immunotherapy for adult autoimmune encephalitis: a systematic review and network meta-analysis
AU - Yan Deng
AU - Yun Cai
AU - Xin Yang
AU - Lihua Xu
AU - Yanan Chen
AU - Na Liu
AU - Weiying Di
PY - 2026
DA - 2026/10/07
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1807436
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1807436/full
AB - 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. Methods: 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. Results: 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). Conclusion: 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. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251085606 , identifier CRD420251085606.
SN - 1664-3224
ER -