Bortezomib for anti-NMDAR encephalitis following daclizumab treatment in a patient with multiple sclerosis

Kushan Karunaratne; Dariush Ahrabian; Bernadette Monoghan; Tom Campion; Tarek Yousry; Michael P Lunn; Michael S Zandi; Robin S Howard; Dimitri M Kullmann; Jennifer Spillane; Matthew Walker; Jeremy Chataway

doi:10.1136/bmjno-2020-000096

Bortezomib for anti-NMDAR encephalitis following daclizumab treatment in a patient with multiple sclerosis

BMJ Neurol Open. 2021 May 18;3(1):e000096. doi: 10.1136/bmjno-2020-000096. eCollection 2021.

Authors

Affiliations

¹ National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
² Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK.
³ MRC Centre for Neuromuscular Disease and Department of Molecular Neuroscience, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK.
⁴ NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.
⁵ Department of Neuromuscular Disorders, UCL Queen Square Institute of Neurology, London, UK.
⁶ Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK.
⁷ Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.

Abstract

Background: Daclizumab is an anti-CD25 monoclonal antibody developed for the treatment of relapsing remitting multiple sclerosis, which was withdrawn worldwide in March 2018, due to emerging serious immune-mediated systemic andcentral nervous system adverse events. We report a case of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis occurring 14 weeks after stopping daclizumab, which responded to the proteasome inhibitor bortezomib.

Methods: Following lack of effective clinical response to first line (corticosteroid, plasma exchange, intravenous immunoglobulin) and second line (rituximab) treatments, bortezomib therapy was commenced. The patient received six cycles of bortezomib treatment.

Results: Clinical improvement was noted 4 weeks after the first of six cycles of bortezomib and the patient experienced sustained clinical improvement.

Conclusion: Our case provides further class IV evidence of the use of bortezomib therapy for treatment refractory anti-NMDAR encephalitis.

Keywords: NMDA; multiple sclerosis.

Abstract

Grants and funding