Bortezomib for treatment of therapy-refractory anti-NMDA receptor encephalitis

Scheibe F, Prüss H, Mengel AM, Kohler S, Nümann A, Köhnlein M, Ruprecht K, Alexander T, Hiepe F, Meisel A. Bortezomib for treatment of therapy-refractory anti-NMDA receptor encephalitis. Neurology. 2017 Jan 24;88(4):366-370.

Abstract

OBJECTIVE:

We assessed the therapeutic potential of the plasma-cell-depleting proteasome inhibitor bortezomib in severe and therapy-refractory cases of anti-NMDA receptor (anti-NMDAR) encephalitis.

METHODS:

Five severely affected patients with anti-NMDAR encephalitis with delayed treatment response or resistance to standard immunosuppressive and B-cell-depleting drugs (corticosteroids, IV immunoglobulins, plasma exchange, immunoadsorption, rituximab, cyclophosphamide) who required medical treatment and artificial ventilation on intensive care units were treated with 1-6 cycles of 1.3 mg/m2 bortezomib. Occurrence of adverse events was closely monitored.

RESULTS:

Bortezomib treatment showed clinical improvement or disease remission, which was accompanied by a partial NMDAR antibody titer decline in 4 of 5 patients. With respect to disease severity, addition of bortezomib to the multimodal immunosuppressive treatment regimen was associated with an acceptable safety profile.

CONCLUSIONS:

Our study identifies bortezomib as a promising escalation therapy for severe and therapy-refractory anti-NMDAR encephalitis.

CLASSIFICATION OF EVIDENCE:

This retrospective case series provides Class IV evidence that bortezomib reduces antibody titers and improves the clinical course of patients with severe anti-NMDAR encephalitis.

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JANUARY 26, 2017

New treatment for a rare form of encephalitis

Charité - Universitätsmedizin Berlin News

Researchers from Charité report success in treating anti–NMDA receptor encephalitis.

Anti–NMDA receptor encephalitis is an inflammatory disease that affects the central nervous system. It is a rare autoimmune disease that results in the body producing antibodies against the NMDA receptor, a protein that plays an important role in signal transduction in the brain. Using a new treatment regimen, researchers from Charité – Universitätsmedizin Berlin and the German Center for Neurodegenerative Diseases (DZNE) have recorded significant progress in treating the disease, including in patients who did not previously respond to treatment.

Results from this study were published in the journal Neurology.

In a study led by Dr. Franziska Scheibe and Prof. Dr. Andreas Meisel from the Department of Neurology and the NeuroCure Cluster of Excellence, Charité–based researchers recorded outcomes obtained using a new treatment regimen. In addition to standard treatment, patients received bortezomib, a drug known as proteasome inhibitor that has proven successful in treating patients with plasmacytoma, a specific type of blood cancer. Proteasomes play an important role in the degradation of proteins that regulate the cell cycle, thereby regulating cell growth. Given their high rates of protein synthesis, antibody–producing plasma cells display particularly high levels of metabolic activity. This renders them as sensitive to the effects of the drug as cancer cells, and results in their death.

In their study of five patients, the researchers were able to show for the first time that bortezomib treatment quickly resulted in clinical improvements in patients with severe forms of the disease. Treatment was also associated with a decline in the antibodies responsible for the disease. 

“'Bortezomib is capable of treating the causes of the disease by eliminating plasma cells. This makes it a valuable new treatment option in cases of anti–NMDA receptor encephalitis that have so far proven resistant to treatment,” explains Franziska Scheibe, the study's first author.

Future studies will focus on developing biomarkers capable of making early predictions on whether patients will develop a severe form of the disease. This should then allow physicians to initiate specific treatments early. “As is the case with all other treatments currently used in patients with this disease, our results need to be confirmed by randomized trials” notes Prof. Andreas Meisel.

https://www.mdlinx.com/neurology/top-medical-news/article/2017/01/26/8