2023 IAE Clinical Abstract

Infectious and autoimmune encephalitis (IAE): Population characteristics and prescribing patterns of immune globulin therapy from this national complex specialty pharmacy provider

Authors: Christine Miller, PharmD; Cori Preble, PhD; Drew Doyle, RPh; Derrek Blake, RN, BSN, IgCN; Mona Dumais, MBA, RPh; Monique Nelson, BS, RN, IgCN – Soleo Health

Introduction

Immunoglobulin (IG) therapy is a widely accepted treatment for infectious and autoimmune encephalitis (IAE), an umbrella term for immune-mediated neuropsychiatric disorders and autoimmune diseases of the nervous system. However, the differential diagnosis process and lack of controlled trials may lead to complications in this patient population, such as payor denials and delayed treatment. This complex specialty pharmacy provider implemented a clinical program to fulfill unmet needs for patients with these complex conditions. The purpose of this study is to identify trends in IAE population characteristics and prescribing patterns of IG therapy

Methods

A retrospective review of medical records was performed for the patients enrolled in this organization’s IAE clinical program from 10/01/2022–05/31/2023. The review consisted of data contained within a customized clinical assessment created by this organization, including diagnosis date, medical care history, identified triggering events, and IAE symptoms. The review also included pharmacy dispensing history, including IG dose, route, and frequency.

The data was collected and analyzed using the proprietary clinical outcomes program, SoleMetrics^®.

Results

Figure 1. Top 10 symptoms reported by IAE patients

Figure 2. IAE triggering events as reported by the patient or caregiver

Table 1. Summary of infections reported as IAE triggering events

Figure 3. Top 10 specialists seen by IAE patients

Table 2. IG therapy prescribing patterns in the IAE population

Discussion

IG dosing for IAE cited throughout available literature is 1–2 g/kg, divided over several days to reduce infusion-related reactions and adverse effects. However, studies often do not provide detailed parameters for long-term management, such as frequency or duration of therapy. Ultimately, IG therapy should be individualized based on patient response and tolerability.

Conclusion

IAE is a complex condition that requires multidisciplinary support. While a majority of the patients had identified triggering events preceding their IAE diagnosis, approximately one-third had unidentified triggers. This study demonstrates that long-term IG therapy is prescribed more often than one-time IG orders for IAE patients referred to complex specialty pharmacy for management. Continuing to collect data through this IAE clinical program offers the opportunity to analyze duration and dose of IG therapy and patient-reported outcome measures in future studies.

References

Abboud H, Probasco J, Irani SR, et al. Autoimmune encephalitis: proposed recommendations for symptomatic and long-term management. J Neurol Neurosurg Psychiatry. 2021;92:897–907. doi: 10.1136/jnnp-2020-325302.
Erickson TA, Muscal E, Munoz FM, et al. Infectious and Autoimmune Causes of Encephalitis in Children. Pediatrics. 2020 Jun;145(6):e20192543. doi: 10.1542/ peds.2019-2543.
Frankovich J, Swedo S, Murphy T, et al. Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part II-Use of Immunomodulatory Therapies. J Child Adolesc Psychopharmacol. 2017 Sep;27(7):574-593. doi: 10.1089/cap.2016.0148.
Patel A, Meng Y, Najjar A, et al. Autoimmune encephalitis: A physician’s guide to the clinical spectrum diagnosis and management. Brain Sci. 2022 Aug 25;12(9):1130. doi: 10.3390/brainsci12091130

A full list of references is available upon request.

Authors of this presentation disclose the following concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this presentation: Nothing to disclose.

Originally presented at IgNS 2023 National Conference and AAN 2024 Annual Meeting