Immunotherapy in Autoantibody-Associated Psychiatric Syndromes in Adults

Abstract

Background: Autoantibody-associated psychiatric syndromes are often distinct from, but might also be part of autoimmune encephalitis. Our article focuses on potential immunotherapy in these patients with a probable autoimmune origin of their psychiatric syndrome.Methods: We searched through PubMed for appropriate articles on immunotherapy in autoantibody-associated psychiatric syndromes between 2010 and 2020 for this narrative review.Results: In line with prior recommendations for autoimmune encephalitis and autoimmune psychosis, we suggest that in patients with a probable autoimmune-based psychiatric syndrome should be given early corticosteroids, intravenous immunoglobulins, or plasmapheresis as first line immunotherapy. If these therapeutic options fail, second-line immunotherapy should be applied within 1 month consisting of rituximab or cyclophosphamide. Maintenance therapy is best for those patients responding to steroids including mycofenolate mofetil or azathioprine. So far, there is evidence from a few retrospective cohort studies supporting the usage of first- and second-line, and maintenance immunotherapies for autoantibody-associated psychiatric syndromes. Some immunological agents are discussed that might exert an effect in autoimmune-based psychiatric syndromes, but the latest evidence is low and derived from case reports or series with autoimmune encephalitis patients.Conclusions: Taken together, the immunotherapeutic landscape for patients with autoantibody-associated psychiatric syndromes is delineated. Our suggestions rely on observational studies in autoantibody-associated psychiatric syndromes and a few placebo-controlled, randomized trials for patients with autoimmune encephalitis and psychosis. Thus, adequate powered, prospective as well as placebo-controlled clinical trials in patients with autoantibody-associated psychiatric syndromes are warranted in order to enlighten efficacy and safety aspects of current and novel therapy strategies.

Case Report: Anti-flotillin 1/2 Autoantibody-Associated Atypical Dementia

“…Blocked flotillin 1 function through anti-flotillin 1/2 autoantibodies might result in altered presynaptic neuronal transmission, possibly affecting cognition. Considering autoimmune-based dementia as experimental therapy after having disclosed test results and treatment options ( 2 , 5 , 14 , 18 , 19 ), we proposed to initiate immunotherapy with high-dose methylprednisolone. Taken together, our case reveals the novelty of serum flotillin 1/2 autoantibodies in probable autoimmune dementia, and expands the clinical spectrum that anti-flotillin 1/2 autoantibodies have exhibited so far.…”

“…We therefore assumed that her dementia probably has an autoimmune-based origin, in line with recent guidelines from Banks et al ( 5 ), which is why she was given corticosteroids starting 6 months after first presentation ( Figure 1 ). We applied a therapeutic regimen for this autoantibody-associated psychiatric syndrome resembling autoimmune dementia, as was recently reviewed ( 14 ). We planned to give her high-dose methylprednisolone intravenously.…”

Three cases with chronic obsessive compulsive disorder report gains in wellbeing and function following rituximab treatment

“…the elevated OCD comorbidity with autoimmune disease 17,18,19 . Psychiatric symptoms have successfully been reduced with immunotherapy in recent observational studies 20,21 . .…”

Increased formation of neutrophil extracellular traps in patients with anti-N-methyl-d-aspartate receptor encephalitis

“…Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis, which is a severe neuroautoimmune disorder, initially manifests as seizures, psychobehavioral abnormalities, and cognitive dysfunction ( 1 ). In most cases, treatment with steroids and immunoglobulins is effective ( 2 ). However, some cases are potentially fatal with patients developing intractable seizures or central hypoventilation ( 3 ).…”