Efficacy and safety of rituximab in autoimmune encephalitis: A meta-analysis

Acta Neurol Scand. 2020 Nov;142(5):449-459. doi: 10.1111/ane.13291. Epub 2020 Jun 16.


Background: Autoimmune encephalitis (AE) is a rare but debilitating neurological disease where the body develops antibodies against neuronal cell surface/synaptic proteins. Rituximab is an anti-CD20 chimeric monoclonal antibody which shows promise in AE treatment observational studies. To our knowledge, there has been no previous meta-analysis providing robust evidence on the effectiveness and safety of rituximab as second-line therapy for the treatment for AE.

Methods: This study was conducted according to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) statement. Investigators independently searched PubMed, Web of Science, Google Scholar, WANFANG, CNKI, and J-STAGE for studies. Meta-analysis via representative forest plots was conducted for good functional outcome (mRS ≤ 2), proportion of relapse, and mRS score change pre- and post-treatment.

Results: Good functional outcome at last follow-up following rituximab therapy occurred in 72.2% of patients (95% CI: 66.3%-77.4%). Mean mRS score decreased by 2.67 (95% CI: 2.04-3.3; P < .001). Relapses following the rituximab therapy occurred in only 14.2% of patients (95% CI: 9.5%-20.8%). Infusion related reactions, pneumonia, and severe sepsis were seen in 29 (15.7%), 11 (6.0%), and two patients (1.1%), respectively. The efficacy and side effect profile of rituximab are comparable to outcomes seen in rituximab use in other autoimmune and inflammatory CNS disease.

Conclusion: Our meta-analysis showed that rituximab is an effective second-line agent for AE with an acceptable toxicity profile.

Keywords: autoimmune; encephalitis; meta-analysis; rituximab.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Encephalitis / drug therapy*
  • Hashimoto Disease / drug therapy*
  • Humans
  • Immunologic Factors / therapeutic use*
  • Male
  • Middle Aged
  • Rituximab / therapeutic use*
  • Treatment Outcome


  • Immunologic Factors
  • Rituximab

Supplementary concepts

  • Hashimoto's encephalitis