Safety and efficacy of intrathecal rituximab in refractory neuroimmune disorders- a case series

Neuroimmunologic diseases pose significant clinical challenges due to their high likelihood of severe neurological presentations and resistance to standard systemic therapeutic strategies. This case series is an explorative study of the safety and efficacy of IT rituximab in neuroinflammatory diseases through clinical case analysis of treatment response and long-term outcomes of 7 cases- including 2 illustrative cases. Case 1 and 2 describe the clinical course and response to intrathecal rituximab of pediatric patients with anti-N-methyl-d-aspartate receptor encephalitis and Rasmussen encephalitis respectively. IT rituximab co-administered with IT corticosteroids in patients with refractory neuroimmunologic conditions was well tolerated in all the cases reviewed, and its use correlated with improvement in neurological symptoms and overall clinical status in 6 of 7 cases within 21 days of administration. In this case series intrathecal treatment provided an alternative strategy that was found to be safe, well-tolerated and effective in cases of refractory neuroimmunologic diseases.