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Current Neurology and Neuroscience Reports
Erschienen in:

11.09.2024 | Review

B-cell Depletion Therapy in Pediatric Neuroinflammatory Disease

verfasst von: Helen C Wu, Grace Y Gombolay, Jennifer H Yang, Jennifer S Graves, Alison Christy, Xinran M Xiang

Erschienen in: Current Neurology and Neuroscience Reports | Ausgabe 10/2024

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Abstract

Purpose of review

B-cell depletion therapy, including anti-CD20 and anti-CD19 therapies, is increasingly used for a variety of autoimmune and conditions, including those affecting the central nervous system. However, B-cell depletion therapy use can be complicated by adverse effects associated with administration and immunosuppression. This review aims to summarize the application of anti-CD20 and anti-CD19 therapies for the pediatric neurologist and neuroimmunologist.

Recent findings

Most existing literature come from clinical trials with adult patients, although more recent studies are now capturing the effects of these therapies in children. The most common side effects include infusion related reactions and increased infection risk from immunosuppression. Several strategies can mitigate infusion related reactions. Increased infections due to persistent hypogammaglobulinemia can benefit from replacement immunoglobulin.

Summary

B-cell depletion therapies can be safe and effective in pediatric patients. Anticipation and mitigation of common adverse effects through primary prevention strategies, close monitoring, and appropriate symptomatic management can improve safety and tolerability.
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• Lee DSW, Rojas OL, Gommerman JL. B cell depletion therapies in autoimmune disease: advances and mechanistic insights. Nat Rev Drug Discov. 2021;20:179–99. Overview of B-cell depletion therapy, including therapies currently being tested or approved for various autoimmune conditions.
• McAtee CL, Lubega J, Underbrink K, et al. Association of rituximab use with adverse events in children, adolescents, and young adults. JAMA Netw Open. 2021;4:e2036321. Large retrospective cohort study of 468 pediatric patients studying the short-term and long-term effects of rituximab on adverse effects, infections, and immune recovery.
• Ghezzi A, Banwell B, Bar-Or A, et al. Rituximab in patients with pediatric multiple sclerosis and other demyelinating disorders of the CNS: practical considerations. Mult Scler. 2021;27:1814–22. Review focusing the use of rituximab in children for pediatric onset multiple sclerosis along with other CNS demyelinating disorders.
• Alvarez E, Longbrake EE, Rammohan KW, Stankiewicz J, Hersh CM. Secondary hypogammaglobulinemia in patients with multiple sclerosis on anti-CD20 therapy: pathogenesis, risk of infection, and disease management. Multiple Sclerosis and Related Disorders. 2023;79:105009. Detailed summary and literature review of hypogammaglobulinemia associated with anti-CD20 therapy along with monitoring and management strategies.
• Gandelman S, Lenzi KA, Markowitz C, Berger JR. A proposed approach to screening and surveillance labs for patients with multiple sclerosis on Anti-CD20 therapy. Neur Clin Pract. 2024;14:e200241. This paper provides a set of useful recommendations and guidelines for initiating and monitoring anti-CD20 therapy in patients with multiple sclerosis.
• Krysko KM, Dobson R, Alroughani R, et al. Family planning considerations in people with multiple sclerosis. The Lancet Neurology. 2023;22:350–66. Informative review and recent updates on safety and tolerability of disease modifying therapies, including B-cell depletion therapy, during and following pregnancy.
Metadaten
Titel
B-cell Depletion Therapy in Pediatric Neuroinflammatory Disease
verfasst von
Helen C Wu
Grace Y Gombolay
Jennifer H Yang
Jennifer S Graves
Alison Christy
Xinran M Xiang
Publikationsdatum
11.09.2024
Verlag
Springer US
Erschienen in
Current Neurology and Neuroscience Reports / Ausgabe 10/2024
Print ISSN: 1528-4042
Elektronische ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-024-01366-7

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Erstmals wird in Deutschland eine S3-Leitlinie zum Thema Suizidalität erarbeitet. Ziel ist es, die Versorgung in suizidalen Krisen durch einheitliche Standards zu verbessern. Erste Ergebnisse der bisherigen Leitlinienarbeit wurden auf dem DGPPN-Kongress vorgestellt.

Kaum Vorteile durch intraarterielle Lyse während Thrombektomie

Nach der Thrombektomie kleinere Fragmente über eine intraarterielle Lyse auflösen – dies könnte die Schlaganfalltherapie verbessern. Zwei aktuelle Studien ergeben für die periprozedurale Lyse jedoch keine großen Vorteile. Die Frage, wie viel sie nützt, bleibt weiter offen.

Nasenstimulation lindert chronische Migräne

Wird die Naseninnenseite durch Vibrationen stimuliert, kann dies offenbar die Zahl der Migränetage von Menschen mit chronischer Migräne deutlich senken. Darauf deuten die Resultate einer randomisiert-kontrollierten deutsch-finnischen Untersuchung.

Update Neurologie

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