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已发表论文
双重滤过血浆置换在急性自身免疫性脑炎中的短期疗效优于静脉注射甲泼尼龙：一项前瞻性观察研究
Authors Li H, Ding J , Li Q, Pei X, Wang K, Peng J, Li W, Zhou X , Zhu D , Guan Y
Received 2 October 2025
Accepted for publication 10 December 2025
Published 15 December 2025 Volume 2025:19 Pages 11163—11172
DOI https://doi.org/10.2147/DDDT.S565677
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Tuo Deng
Hongyan Li,1,* Jie Ding,2,* Qiuju Li,1 Xuzhong Pei,1 Kan Wang,2 Jing Peng,2 Wanwan Li,2 Xiajun Zhou,2 Desheng Zhu,2 Yangtai Guan1
1Department of Neurology, Punan Branch of Renji Hospital, Shanghai Jiao Tong University School of Medicine (Punan Hospital in Pudong New District), Shanghai, 200125, People’s Republic of China; 2Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Yangtai Guan, Department of Neurology, Punan Branch of Renji Hospital, Shanghai Jiao Tong University School of Medicine (Punan Hospital in Pudong New District), Shanghai, 200125, People’s Republic of China, Tel +86 13386271865, Fax +86 21 68383482, Email guanyangtai@renji.com Desheng Zhu, Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160, Pujian Road, Shanghai, 200127, People’s Republic of China, Tel +86 13564719779, Email zhudesheng@renji.com
Background: Autoimmune encephalitis (AE) is a severe neurological disorder, but limited evidence comparing the efficacy of double filtration plasmapheresis (DFPP) and intravenous methylprednisolone (IVMP) as first-line treatments in the acute phase. This study aimed to evaluate the clinical outcomes of DFPP versus IVMP in antibody-positive patients with AE.
Methods: A prospective observational cohort study was conducted at Renji Hospital from July 2018 to May 2024. Thirty-eight patients with antibody-confirmed AE in the acute phase who received either DFPP (n=22) or IVMP (n=16) as first-line therapy were included. The primary outcome was improvement in the Modified Rankin Scale (mRS), and the secondary outcome was improvement in the Clinical Assessment Scale for Autoimmune Encephalitis (CASE). Adverse events were recorded for safety assessment. Univariate and multivariate logistic regression analyses were performed.
Results: The DFPP group demonstrated significantly higher rates of functional improvement, with 68.2% (15/22) achieving mRS reduction compared to 31.3% (5/16) in the IVMP group (p=0.047). Similarly, symptomatic improvement (CASE score reduction) was observed in 72.7% (17/22) of DFPP patients versus 43.8% (7/16) with IVMP (p=0.099). Multivariate analysis identified DFPP as the sole independent predictor of better outcomes (OR: 5.234, 95% CI: 1.179– 23.235, p=0.030). Adverse events were limited to the DFPP group (3/22), including manageable deep venous thrombosis and hepatic impairment.
Conclusion: DFPP demonstrated superior short-term efficacy compared to IVMP in improving functional and symptomatic outcomes in acute-phase AE, suggesting its potential as a preferred first-line therapy. Further large-scale randomized trials are warranted to validate these findings.
Keywords: Autoimmune encephalitis, double filtration plasmapheresis, intravenous methylprednisolone, plasma exchange, immunotherapy, acute-phase
1Department of Neurology, Punan Branch of Renji Hospital, Shanghai Jiao Tong University School of Medicine (Punan Hospital in Pudong New District), Shanghai, 200125, People’s Republic of China; 2Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Yangtai Guan, Department of Neurology, Punan Branch of Renji Hospital, Shanghai Jiao Tong University School of Medicine (Punan Hospital in Pudong New District), Shanghai, 200125, People’s Republic of China, Tel +86 13386271865, Fax +86 21 68383482, Email guanyangtai@renji.com Desheng Zhu, Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160, Pujian Road, Shanghai, 200127, People’s Republic of China, Tel +86 13564719779, Email zhudesheng@renji.com
Background: Autoimmune encephalitis (AE) is a severe neurological disorder, but limited evidence comparing the efficacy of double filtration plasmapheresis (DFPP) and intravenous methylprednisolone (IVMP) as first-line treatments in the acute phase. This study aimed to evaluate the clinical outcomes of DFPP versus IVMP in antibody-positive patients with AE.
Methods: A prospective observational cohort study was conducted at Renji Hospital from July 2018 to May 2024. Thirty-eight patients with antibody-confirmed AE in the acute phase who received either DFPP (n=22) or IVMP (n=16) as first-line therapy were included. The primary outcome was improvement in the Modified Rankin Scale (mRS), and the secondary outcome was improvement in the Clinical Assessment Scale for Autoimmune Encephalitis (CASE). Adverse events were recorded for safety assessment. Univariate and multivariate logistic regression analyses were performed.
Results: The DFPP group demonstrated significantly higher rates of functional improvement, with 68.2% (15/22) achieving mRS reduction compared to 31.3% (5/16) in the IVMP group (p=0.047). Similarly, symptomatic improvement (CASE score reduction) was observed in 72.7% (17/22) of DFPP patients versus 43.8% (7/16) with IVMP (p=0.099). Multivariate analysis identified DFPP as the sole independent predictor of better outcomes (OR: 5.234, 95% CI: 1.179– 23.235, p=0.030). Adverse events were limited to the DFPP group (3/22), including manageable deep venous thrombosis and hepatic impairment.
Conclusion: DFPP demonstrated superior short-term efficacy compared to IVMP in improving functional and symptomatic outcomes in acute-phase AE, suggesting its potential as a preferred first-line therapy. Further large-scale randomized trials are warranted to validate these findings.
Keywords: Autoimmune encephalitis, double filtration plasmapheresis, intravenous methylprednisolone, plasma exchange, immunotherapy, acute-phase