Case Report: Ofatumumab for the treatment of refractory anti-NMDAR-positive autoimmune encephalitis
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By
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Yekai Ma
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Yani Tang
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Qinyue Peng
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Weiqing Zhang
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Yongjun Wu
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Jun Chen
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Susu Xiong
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Dong Lv
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June 10, 2026
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Clinical Scorecard: Clinical Case Series: Efficacy of Ofatumumab in Patients with Refractory Anti-NMDAR Autoimmune Encephalitis
At a Glance
| Category | Detail |
|---|
| Condition | Refractory Anti-NMDAR Autoimmune Encephalitis |
| Key Mechanisms | Autoantibodies targeting the NMDAR GluN1 subunit leading to synaptic dysfunction. |
| Target Population | Patients with refractory anti-NMDAR encephalitis unresponsive to first-line and second-line treatments. |
| Care Setting | Multidisciplinary clinical care with dynamic monitoring. |
Key Highlights
- Ofatumumab (OFA) shows significant improvement in psychiatric symptoms and cognitive function.
- CD20+ B cell levels declined to extremely low levels post-treatment.
- Only one patient experienced mild adverse effects; no severe events reported.
- OFA offers advantages over rituximab, including lower immunogenicity and fewer infusion reactions.
- All patients regained the ability to perform daily activities.
Guideline-Based Recommendations
Diagnosis
- Diagnosis based on clinical symptoms and positive anti-NMDAR antibody tests.
Management
- Initiate second-line immunotherapy with OFA for refractory cases.
Monitoring & Follow-up
- Dynamic monitoring of CD20+ B cell levels, antibody titers, imaging findings, and neurological function scores.
Risks
- Potential risks associated with rituximab include infusion reactions and severe infections.
Patient & Prescribing Data
Patients with refractory anti-NMDAR encephalitis.
OFA administered via subcutaneous injection at a dose of 20 mg per treatment.
Clinical Best Practices
- Consider OFA for patients unresponsive to conventional treatments.
- Monitor for adverse effects and adjust treatment as necessary.
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