Treatment of refractory anti-NMDAR and anti-LGI1 encephalitis with Taitacept

Efficacy and Safety of Taitacept in Treatment of Refractory or Recurrent Anti-NMDAR/anti-LGI1 Encephalitis

This study is testing if adding Taitacept to regular treatments can help people with tough cases of anti-NMDAR and anti-LGI1 encephalitis feel better.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 10 (estimated)
• Ages: 14 Years and up
• Sex: All
• Sponsor: Beijing Tongren Hospital (Academic / other)
• Drugs / interventions: rituximab, cyclophosphamide
• Locations: 1 site (Beijing, Beijing Municipality)
• Trial ID: NCT06510283 on ClinicalTrials.gov

What this trial studies

This clinical trial investigates the efficacy and safety of Taitacept as an add-on therapy for patients suffering from refractory or recurrent anti-NMDAR and anti-LGI1 encephalitis. It is a prospective, single-center, open-label study that aims to evaluate how well Taitacept works in conjunction with traditional treatments. Participants will be monitored for improvements in symptoms associated with autoimmune encephalitis over a specified period.

Who should consider this trial

Good fit: Ideal candidates are individuals aged 14 and older who have been diagnosed with autoimmune encephalitis and exhibit symptoms within the last nine months.

Not a fit: Patients with other well-defined encephalitis syndromes or those who do not meet the diagnostic criteria for anti-NMDAR or anti-LGI1 encephalitis may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could provide significant relief and improved outcomes for patients with difficult-to-treat autoimmune encephalitis.

How similar studies have performed: While there is ongoing research in this area, the specific use of Taitacept for these conditions is novel and has not been extensively tested in prior studies.

Eligibility criteria

Inclusion Criteria:

1. Age ≥14 years old, male or female;
2. Symptoms of autoimmune encephalitis (AE) ≤ 9 months prior to enrollment;
3. Diagnosed as autoimmune encephalitis, diagnostic criteria as follows:

   1. Rapid onset (\<3 months) of at least four of the following six major symptoms:

      * Abnormal (mental) behavior or cognitive dysfunction
      * Speech dysfunction (verbal urgency, hypospeech, mutism)
      * Seizures
      * Movement disorders, dyskinesias, or postural rigidity/abnormalities
      * Decreased level of consciousness
      * Autonomic dysfunction or central hypoventilation in the presence of one or more of the six major symptoms;
   2. Positive anti-NMDAR (GluN1) IgG antibody detected in CSF or positive serum and/or cerebrospinal fluid LGI1 antibody; c．Reasonable exclusion of other etiologies and other well-defined encephalitis syndromes (e.g., Bickerstaff brainstem encephalitis, acute disseminated encephalomyelitis, Hashimoto encephalopathy, primary CNS vasculitis, Rasmussen encephalitis);
4. Refractory AE: ineffective treatment with steroids and rituximab or other immunosuppressants, post-treatment mRS score≥2 (stable for at least 24 hours）;Recurrent AE: at least 2 months after 1st or 2nd line treatment, new symptoms or worsening of existing symptoms (mRS increase\>1); 5）Doses of steroids and other immunosuppressants (e.g. azathioprine, mycophenolate mofetil, cyclophosphamide) should be stabilised for 4 weeks prior to enrolment; 6）Ability to obtain patient or proxy consent; 7）Women of childbearing potential should use effective contraception during treatment or avoid heterosexual intercourse for at least 3 months after the last dose of talitacicept;

Exclusion Criteria:

1. History of other autoimmunity such as SLE, RA, SS. Patients with hyperthyroidism and hypothyroidism cannot be excluded;
2. Abnormal laboratory indicators, including but not limited to the following indicators:

   White blood cell count\<3×10\^9 /L Neutrophil count\<1.5×10\^9 /L Hemoglobin\<85g/L Blood platelet count\<80×10\^9 /L Serum creatinine\>1.5×ULN TBil(total bilirubin) \>1.5×ULN ALT\>3× ULN AST\>3× ULN Alkaline phosphatase\>2× ULN Creatine kinase\>5× ULN
3. Evidence of active infection such as shingles, HIV or active tuberculosis, etc.
4. Currently have active hepatitis or have severe liver disease and a history of it.

   * Patiens with abnormal Hepatitis B test as follows should be excluded: HbsAg positive; HbsAg negative but HbcAb positive, and HBV-DNA positive. Whereas patients with HbsAg negative but HbcAb positive, and HBV-DNA negative can be included.
   * Exclude patients who are positive for hepatitis C antibodies ;
5. Uncontrolled diabetes mellitus: Glycosylated hemoglobin\>9.0% or fasting blood glucose≥11.1mmol/L;
6. Received any live vaccine within 3 months prior to enrollment or planned to receive any vaccine during the study;
7. Received rituximab or other biological therapies within 1 month prior to enrollment;
8. Malignancy;
9. Allergic to human biological products;
10. Participated in any clinical trial within 28 days prior to enrollment or within 5 times the half-life of the investigational drug participating in the clinical trial
11. Patients who plan to have children during the trial, or who are pregnant or breastfeeding;
12. Alcohol or drug abuse/addiction is known to have an impact on compliance with trial requirements;
13. Patients who are deemed unsuitable for the trial by the investigator (e.g., those with severe mental disorders).

Where this trial is running

Beijing, Beijing Municipality

• Beijing Tongren Hospital,Capital Medical University — Beijing, Beijing Municipality, China (Recruiting)

Study contacts

• Study coordinator: Jiawei Wang, PHD

Conditions Anti-N-Methyl-D-Aspartate Receptor Encephalitis