Current and future immunotherapy targets in autoimmune neurology.
Randomized controlled treatment trials of autoimmune neurologic disorders are generally lacking and data pertaining to treatment are mostly derived from expert opinion, large case series, and anecdotal reports. The treatment of autoimmune neurologic disorders comprises oncologic therapy (where appropriate) and immunotherapy. In this chapter, we first describe the standard acute and chronic immunotherapies and provide a practical overview of their use in the clinic (mechanisms of action, dosing, monitoring, and side effects). Novel approaches to treatment of autoimmune neurologic disorders, through new drug discovery or repurposing, are dependent on improved mechanistic understanding of immunopathology. Such approaches, with emphasis on monoclonal antibodies, are discussed using the paradigm of three autoimmune neurologic disorders whose immunopathogenesis is better understood, specifically myasthenia gravis, neuromyelitis optica, and chronic inflammatory demyelinating polyradiculoneuropathy. It is important to realize that the treatment strategy and management plan must be individualized for each patient. In general these are influenced by the following: clinical severity, antibody type, presence or absence of cancer, and prior treatment response, if known.
Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
Melody Y
MY
Hu
Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
Panos
P
Stathopoulos
Department of Neurology, Yale School of Medicine, New Haven, CT, USA. Electronic address: kevin.oconnor@yale.edu.
Kevin C
KC
O'connor
Departments of Laboratory Medicine/Pathology and Neurology, Mayo Clinic, College of Medicine, Rochester, MN, USA.
Sean J
SJ
Pittock
Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
Richard J
RJ
Nowak
D001327:Autoimmune Diseases / Q000150:complications / Q000628:therapy*; D006801:Humans; D007167:Immunotherapy / Q000379:methods* / Q000639:trends; D009422:Nervous System Diseases / Q000150:complications / Q000628:therapy*
autoimmunity; chronic inflammatory demyelinating polyradiculoneuropathy; immunopathology; immunosuppressive therapy; immunotherapy; myasthenia gravis; neuroimmunology; neurologic disorders; neuromyelitis optica