{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:49:53Z","timestamp":1791352193607,"version":"4.3.1"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Autoimmune encephalitis (AE) is an immune-mediated inflammatory disorder of the central nervous system associated with substantial morbidity. Acute-phase immunotherapy is crucial for improving outcomes, yet the comparative efficacy and safety of available regimens remain unclear. We therefore performed a Bayesian network meta-analysis to compare acute-phase immunotherapeutic strategies for AE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to October 2025 for studies evaluating acute-phase immunotherapy in AE. A Bayesian network meta-analysis was conducted. The primary outcome was change in the modified Rankin Scale (mRS) after treatment; adverse events were secondary outcomes. Effects were expressed as mean differences (MD) and risk ratios (RRs) with 95% credible intervals (CrIs). The surface under the cumulative ranking curve (SUCRA) was used to rank interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eleven studies (1,359 patients) were included, evaluating seven strategies: intravenous methylprednisolone (IVMP), intravenous immunoglobulin (IVIG), IVMP+IVIG, IVMP+plasma exchange (PE), IVMP+IVIG+PE, IVMP+immunoadsorption (IA), and IVMP+efgartigimod (EFG). For efficacy, IVMP+EFG ranked highest in mRS improvement among the included regimens (MD = \u22120.99, 95% CrI \u22121.30 to \u22120.68; SUCRA\u00a0=\u00a095%), followed by IVMP+IA (MD = \u22120.87; SUCRA\u00a0=\u00a088%). IVMP+PE ranked lowest (MD\u00a0=\u00a00.32; SUCRA\u00a0=\u00a00.2%). For safety, IVIG monotherapy had the lowest adverse-event risk (RR\u00a0=\u00a00.51, 95% CrI 0.24 to 0.97), whereas IVMP+PE had the highest risk (RR\u00a0=\u00a03.10, 95% CrI 0.92 to 9.60).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Acute-phase immunotherapy for AE should be individualized by disease severity and antibody subtype. Consistent directional findings were observed in the anti-NMDAR subgroup and, separately, in the subgroup with baseline mRS \u22653. IVMP+EFG and IVMP+IA ranked favorably for short-term functional improvement, although the evidence was based mainly on observational studies and small sample sizes. IVIG remained a reasonable option given its favorable safety profile.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251085606<\/jats:ext-link>\n                      , identifier CRD420251085606.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1807436","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:50:56Z","timestamp":1791348656000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of acute-phase immunotherapy for adult autoimmune encephalitis: a systematic review and network meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Yan","family":"Deng","sequence":"first","affiliation":[{"name":"Department of Neurology, Affiliated Hospital of Hebei University","place":["Baoding, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Neurology, Affiliated Hospital of Hebei University","place":["Baoding, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Affiliated Hospital of Hebei University","place":["Baoding, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihua","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Affiliated Hospital of Hebei University","place":["Baoding, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Affiliated Hospital of Hebei University","place":["Baoding, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Affiliated Hospital of Hebei University","place":["Baoding, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiying","family":"Di","sequence":"additional","affiliation":[{"name":"Department of Neurology, Affiliated Hospital of Hebei University","place":["Baoding, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.4103\/0366-6999.180514","article-title":"Autoimmune encephalitis: An expanding frontier of neuroimmunology","volume":"129","author":"Guan","year":"2016","journal-title":"Chin Med J (Engl)"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25131","article-title":"Autoimmune encephalitis epidemiology and a comparison to infectious encephalitis","volume":"83","author":"Dubey","year":"2018","journal-title":"Ann Neurol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1111\/ene.70113","article-title":"Retrograde amnesia in LGI1 and CASPR2 limbic encephalitis: Two case reports and a systematic literature review","volume":"32","author":"Antonio","year":"2025","journal-title":"Eur J Neurol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1038\/s41420-025-02459-z","article-title":"Immunotherapy for autoimmune encephalitis","volume":"11","author":"Cheng","year":"2025","journal-title":"Cell Death Discov"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1111\/trf.16644","article-title":"Immunoadsorption with staphylococcal protein A column in autoimmune encephalitis","volume":"61","author":"Chen","year":"2021","journal-title":"Transfusion"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1172\/jci97911","article-title":"Neonatal Fc receptor antagonist efgartigimod safely and sustainably reduces IgGs in humans","volume":"128","author":"Ulrichts","year":"2018","journal-title":"J Clin Invest"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1002\/brb3.70491","article-title":"Does the use of intravenous immunoglobulin improve clinical outcomes in adults with autoimmune encephalitis? 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