CASE REPORT article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders: Autoinflammatory Disorders
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1640281
This article is part of the Research TopicClinical and Immunological Phenotypic Characterization to better understand Pathogenesis and Response to Therapies in Systemic Autoimmune DiseasesView all 5 articles
Successful Sequential Treatment with Ofatumumab Followed by Efgartigimod for Refractory Autoimmune Encephalitis with Dual Anti-NMDAR and Anti-GFAP Antibody Positivity: First Case Report
Provisionally accepted
- 1Zhongnan Hospital, Wuhan University, Wuhan, China
- 2Wuhan Hanyang Hospital, Wuhan, China
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Autoimmune encephalitis (AE) is a heterogeneous disorder mediated by autoantibodies targeting neuronal or glial antigens, with anti-NMDAR encephalitis being the most common subtype,while cases with dual antibody positivity remain exceedingly rare.Standard treatment involves stepwise immunotherapy, but refractory cases often require advanced therapies. This study presents the first reported case of dual anti-NMDAR and anti-GFAP antibody-positive refractory AE in a 24-year-old female who failed first-line treatments (steroids, IVIG) and ovarian teratoma resection. During disease progression, innovative sequential therapy with ofatumumab (OFA), a novel anti-CD20 monoclonal antibody, followed by efgartigimod, an FcRn antagonist, was employed to mitigate profound B-cell depletion risks.The patient exhibited significant clinical improvement, with reduced Modified Rankin Scale (mRS) scores from 5 to 1. OFA induced rapid B-cell depletion, while efgartigimod effectively cleared pathogenic IgG, demonstrating synergistic efficacy. Comparative analysis with literature cases highlighted the superiority of this sequential approach in balancing efficacy and safety.
Keywords: autoimmune encephalitis, anti-NMDAR, anti-GFAP, Ofatumumab, efgartigimod
Received: 03 Jun 2025; Accepted: 28 Jul 2025.
Copyright: © 2025 Tu, Liu, Yang, Sun, Mei and Yan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Dong Sun, Zhongnan Hospital, Wuhan University, Wuhan, China
Bin Mei, Zhongnan Hospital, Wuhan University, Wuhan, China
Nao Yan, Zhongnan Hospital, Wuhan University, Wuhan, China
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