- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04372615
The ExTINGUISH Trial of Inebilizumab in NMDAR Encephalitis (ExTINGUISH)
A Phase-2b, Double-Blind, Randomized Controlled Trial to Evaluate the Activity and Safety of Inebilizumab in Anti-Nmda Receptor Encephalitis and Assess Markers of Disease
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Stacey L Clardy, MD, PhD
- Phone Number: 8015857575
- Email: stacey.clardy@hsc.utah.edu
Study Contact Backup
- Name: Ka-Ho Wong, MBA
- Phone Number: 8015857575
- Email: ka-ho.wong@hsc.utah.edu
Study Locations
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Rotterdam, Netherlands
- Recruiting
- Erasmus Medical University Center
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Principal Investigator:
- Maarten Titulaer, MD
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Contact:
- Wendy Hamerslag-de Groot
- Phone Number: 29066799230
- Email: w.degroot.1@erasmusmc.nl
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Rotterdam, Netherlands
- Recruiting
- Erasmus University Rotterdam
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Contact:
- Anne-Marieke Vegter
- Phone Number: +31 10 704 01 30
- Email: a.vegter@erasmusmc.nl
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Principal Investigator:
- Maarten Titulaer
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Barcelona, Spain
- Recruiting
- Hospital Clinic Barcelona
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Contact:
- Montse Artola
- Phone Number: +34 93 227 54 00 (Ext. 3271)
- Email: martola@clinic.cat
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Principal Investigator:
- Mar Guasp
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Barcelona, Spain
- Recruiting
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona
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Principal Investigator:
- Josep Dalmau
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Contact:
- Dalmau Josep
- Phone Number: 93 227 99 51
- Email: ope@clinic.cat
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Alabama
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Birmingham, Alabama, United States, 35233
- Recruiting
- University of Alabama at Birmingham
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Contact:
- Melanie Benge
- Email: Melaniebenge@uabmc.edu
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Principal Investigator:
- Louis Nabors
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Arizona
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Phoenix, Arizona, United States, 85013
- Recruiting
- St. Joseph Hospital and Medical Center Barrow Neurological Institute
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Contact:
- Mary Thornton
- Phone Number: 602-406-6287
- Email: mary.thornton@dignityhealth.org
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Principal Investigator:
- Michael Robers, MD
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Scottsdale, Arizona, United States, 85259
- Recruiting
- Mayo Clinic in Arizona
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Contact:
- Erica Boyd
- Phone Number: 480-301-8000
- Email: Boyd.Erica@mayo.edu
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Principal Investigator:
- Marie Grill
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California
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Orange, California, United States, 92868
- Recruiting
- Children's Hospital of Orange County
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Contact:
- Linda Do
- Phone Number: 714-997-3000
- Email: Linh.Do@choc.org
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Principal Investigator:
- Janetta Arellano, MD
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Orange, California, United States, 92868
- Recruiting
- UC Irvine
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Contact:
- Isela Hernandez
- Phone Number: 714-509-2664
- Email: iselah@uci.edu
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Principal Investigator:
- Xiao-Tang Kong, MD
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Sacramento, California, United States, 95816
- Recruiting
- UC Davis
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Contact:
- Lynea Kaethler
- Phone Number: 916-734-3993
- Email: lbkaethler@ucdavis.edu
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Contact:
- Erica Goude
- Phone Number: 916-734-0384
- Email: emgoude@ucdavis.edu
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Principal Investigator:
- Mustafa Ansari, MD
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Colorado
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Aurora, Colorado, United States, 80045
- Recruiting
- University of Colorado
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Contact:
- Jordan Hood
- Phone Number: 720-240-1329
- Email: jordan.j.hood@cuanschutz.edu
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Principal Investigator:
- Amanda Piquet
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Aurora, Colorado, United States, 80045
- Recruiting
- Children's Hospital Colorado Main Campus
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Contact:
- Diana Rodriguez
- Phone Number: 720-777-9214
- Email: Diana.Rodriguez@childrenscolorado.org
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Principal Investigator:
- Ryan Kammeyer, MD
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Connecticut
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New Haven, Connecticut, United States, 06510
- Recruiting
- Yale University
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Contact:
- Danielle Paquette
- Email: danielle.paquette@yale.edu
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Principal Investigator:
- Erin Longbrake, MD
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Florida
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Jacksonville, Florida, United States, 32224
- Recruiting
- Mayo Clinic Jacksonville
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Contact:
- Pamela Desaro
- Phone Number: 904-953-7720
- Email: Desaro.Pamela@mayo.edu
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Principal Investigator:
- Gregory Day, MD
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Miami, Florida, United States, 33136
- Recruiting
- University of Miami
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Contact:
- Julie Steele
- Phone Number: 305-775-9502
- Email: jsteele@med.miami.edu
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Contact:
- Danielle Bass
- Phone Number: 305-243-6320
- Email: dhb55@med.miami.edu
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Principal Investigator:
- Ayham Alkhachroum
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Georgia
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Atlanta, Georgia, United States, 30322
- Recruiting
- Emory University
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Contact:
- Connor McMillan
- Phone Number: 404-727-3818
- Email: connor.logan.mcmillan@emory.edu
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Principal Investigator:
- Erika Sigman
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Illinois
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Chicago, Illinois, United States, 60611
- Recruiting
- Northwestern University Feinberg School of Medicine
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Contact:
- Monika Szela
- Email: monika.szela@northwestern.edu
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Principal Investigator:
- Elena Grebenciucova, MD
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Chicago, Illinois, United States, 60611
- Recruiting
- Ann and Robert H. Lurie Childrens Hospital of Chicago
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Contact:
- Alexandra Byrd
- Phone Number: 312-227-4000
- Email: albyrd@luriechildrens.org
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Principal Investigator:
- Kavita Thakkar, MD
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Iowa
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Iowa City, Iowa, United States, 52242
- Recruiting
- University of Iowa
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Contact:
- Loraine Brenner
- Phone Number: 319-356-4361
- Email: loraine-brenner@uiowa.edu
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Principal Investigator:
- Tracey Cho, MD
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Massachusetts
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Boston, Massachusetts, United States, 02114
- Recruiting
- Massachusetts General Hospital
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Contact:
- Rina Dhawlikar
- Phone Number: 908-601-8967
- Email: rdhawlikar@mgh.harvard.edu
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Contact:
- Santiago Pardo
- Phone Number: 410-926-6248
- Email: SPARDO1@mgh.harvard.edu
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Principal Investigator:
- Michael Levy, MD
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Michigan
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Ann Arbor, Michigan, United States, 48109
- Recruiting
- University of Michigan Health System
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Contact:
- Amanda Rasnake
- Phone Number: 734-232-2452
- Email: arasnake@med.umich.edu
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Principal Investigator:
- Craig Williamson, MD
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Minnesota
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Rochester, Minnesota, United States, 55905
- Recruiting
- Mayo Clinic Rochester
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Contact:
- Morgan Mohler
- Phone Number: 507-284-2511
- Email: mohler.morgan@mayo.edu
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Principal Investigator:
- Anastasia Zekeridou
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Missouri
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Saint Louis, Missouri, United States, 63110
- Recruiting
- Washington University in St. Louis School of Medicine
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Contact:
- Mengesha Teshome
- Phone Number: 314-747-8420
- Email: teshomem@wustl.edu
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Principal Investigator:
- Steven Dunham, MD
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New York
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Brooklyn, New York, United States, 11203
- Recruiting
- SUNY Downstate
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Contact:
- Nadege Gilles
- Phone Number: 718-270-7786
- Email: Nadege.Gilles@Downstate.edu
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Contact:
- Sofya Glazman
- Email: Sofya.Glazman@downstate.edu
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Principal Investigator:
- Yaacov Anziska
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New York, New York, United States, 10029
- Recruiting
- Mount Sinai
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Contact:
- Kevin Van Geem
- Phone Number: 347-804-3699
- Email: kevin.vangeem@mssm.edu
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Principal Investigator:
- Pojen Deng
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Sub-Investigator:
- Sammita Satyanarayan
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Sub-Investigator:
- Jiyeoun Yoo
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New York, New York, United States, 10033
- Recruiting
- Columbia University Medical Center
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Contact:
- Jennie Mata
- Email: jmm2220@cumc.columbia.edu
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Principal Investigator:
- Sarah Wesley, MD
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Rochester, New York, United States, 14618
- Recruiting
- University of Rochester
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Principal Investigator:
- Andrew Goodman, MD
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Contact:
- Christine Anne
- Phone Number: 585-276-3037
- Email: Christine_annis@urmc.rochester.edu
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Williamsville, New York, United States, 14221
- Recruiting
- SUNY Buffalo
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Contact:
- Kara Patrick
- Phone Number: 716-829-5037
- Email: kpatrick@buffalo.edu
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Contact:
- Annemarie Crumlish
- Phone Number: 716-829-5046
- Email: ac35@buffalo.edu
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Principal Investigator:
- Eckert Svetlana
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North Carolina
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Winston-Salem, North Carolina, United States, 27101
- Recruiting
- Wake Forest University Health Sciences
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Principal Investigator:
- Roy Strowd, MD
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Contact:
- Carolina Burgos
- Email: caguilar@wakehealth.edu
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Ohio
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Cincinnati, Ohio, United States, 45219
- Recruiting
- University of Cincinnati
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Principal Investigator:
- Aram Zabeti, MD
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Contact:
- Tiffany Rupert
- Phone Number: 513-558-0269
- Email: rupertts@ucmail.uc.edu
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Contact:
- Angela Molloy
- Phone Number: 513-558-7118
- Email: angela.molloy@uc.edu
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Columbus, Ohio, United States, 43210
- Recruiting
- Ohio State University
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Contact:
- Casey Mitchell
- Phone Number: 614-685-9906
- Email: casey.mitchell@osumc.edu
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Contact:
- Marina Rodriguez
- Phone Number: 614-366-2840
- Email: marina.rodriguez@osumc.edu
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Principal Investigator:
- Tirisham Gyang
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Sub-Investigator:
- Allison Jordan
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Pennsylvania
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Philadelphia, Pennsylvania, United States, 19104
- Recruiting
- University of Pennsylvania
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Principal Investigator:
- Eric Lancaster, MD
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Contact:
- Priyanka Kalyani
- Phone Number: 215-820-2726
- Email: Priyanka.Kalyani@Pennmedicine.upenn.edu
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Pittsburgh, Pennsylvania, United States, 15213
- Recruiting
- University of Pittsburgh
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Contact:
- Dane Prince
- Phone Number: 262-490-6818
- Email: princede2@upmc.edu
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Contact:
- Kerry Oddis
- Phone Number: 412-692-4918
- Email: kmoddis@upmc.edu
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Principal Investigator:
- Lori Shutter
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Tennessee
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Nashville, Tennessee, United States, 37212
- Recruiting
- Vanderbilt University
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Contact:
- Ryann Gardner
- Phone Number: 615-322-4085
- Email: ryann.gardner@vumc.org
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Contact:
- Kehaunani Hubbard
- Phone Number: 615-322-4322
- Email: kehaunani.m.hubbard@vumc.org
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Principal Investigator:
- Siddharama Pawate, MD
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Texas
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Dallas, Texas, United States, 75390
- Recruiting
- University of Texas Southwestern Medical Center
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Contact:
- Amy Conger
- Phone Number: 214-645-8208
- Email: amy.conger@utsouthwestern.edu
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Principal Investigator:
- Kyle Blackburn, MD
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Houston, Texas, United States, 77030
- Recruiting
- Texas Children's Hospital
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Contact:
- Navjot Sandhu
- Phone Number: 832-824-1000
- Email: Navjot.Sandhu@bcm.edu
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Principal Investigator:
- Kristen Fisher
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Utah
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Salt Lake City, Utah, United States, 84108
- Recruiting
- University of Utah
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Contact:
- Ka-Ho Wong, MBA
- Phone Number: 8015857575
- Email: ka-ho.wong@hsc.utah.edu
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Contact:
- Stacey L Clardy, MD, PhD
- Phone Number: 801-585-7575
- Email: stacey.clardy@hsc.utah.edu
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Principal Investigator:
- Stacey Clardy
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Virginia
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Charlottesville, Virginia, United States, 22903
- Recruiting
- University of Virginia
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Contact:
- Kay Maupin
- Phone Number: 434-982-6961
- Email: klm8a@hscmail.mcc.virginia.edu
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Principal Investigator:
- Meena Kannan, MD
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Washington
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Seattle, Washington, United States, 98195
- Recruiting
- University of Washington
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Contact:
- Ashtyn Winter
- Phone Number: 206-598-7688
- Email: ashtynw@uw.edu
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Principal Investigator:
- Yujie Wang, MD
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria
Diagnosis of NMDAR encephalitis, defined by both a and b:
- A subacute onset of change in mental status consistent with autoimmune encephalitis,
- A positive cell-based assay for anti-NMDA receptor IgG antibody in the CSF confirmed in study-specified laboratories.
- Participants, ≥ 12 years of age at the time of informed consent. Participants under 18 years of age must weigh ≥40 kilograms.
- Written informed consent and any locally required authorization (e.g., Health Insurance Portability and Accountability Act [HIPAA] in the United States of America [USA], European Union [EU] Data Privacy Directive in the EU) obtained from the participant/legal representative prior to performing any protocol-related procedures, including screening evaluations.
Non-sterilized participants who are sexually active with a partner capable of becoming pregnant must use a condom with spermicide from Day 1 through to the end of the study and must agree to continue using such precautions for at least 6 months after the final dose of IP. A recommendation will be made that the partners (capable of becoming pregnant) of study participants (capable of getting their partner pregnant) should use a highly effective method of contraception other than a physical method.
Participants of childbearing potential who are sexually active with a non-sterilized partner capable of getting their partner pregnant must agree to use a highly effective method of contraception beginning at screening or upon discharge from hospitalization/inpatient rehabilitation (for participants who were incapacitated at the time of screening), and to continue precautions for 12 months after the final dose of IP.
- Participants of childbearing potential are defined as those who are not surgically sterile (e.g., bilateral tubal ligation, bilateral oophorectomy, or complete hysterectomy) or those who are not postmenopausal (per ICH M3 (R2) 11.2: defined as 12 months with no menses without an alternative medical cause).
A highly effective method of contraception is defined as one that results in a low failure rate (i.e., less than 1% per year) when used consistently and correctly. Periodic abstinence, the rhythm method, and the withdrawal method do not qualify as "highly effective" or acceptable methods of contraception for study purposes. Acceptable methods of contraception are listed in the table below:
Physical Methods Hormonal Methods e
• Intrauterine device (IUD)
• Intrauterine hormone-releasing system, also known as drug-eluting IUD a
• Bilateral tubal occlusion
• Vasectomized partner b
• Sexual abstinence c • Combined (estrogen and progestogen-containing hormonal contraception)
- Oral (combined pill)
- Injectable
- Transdermal (patch)
- Progestogen-only hormonal contraception associated with inhibition of ovulation d
- Implantable
- Intravaginal a This is also considered to be a hormonal method. b With appropriate post-vasectomy documentation of surgical success (absence of sperm in ejaculate).
c Sexual abstinence is considered to be a highly effective method only if defined as refraining from heterosexual intercourse during the entire period of the study and if it is the preferred and usual lifestyle of the participant.
d Progestogen-only hormonal contraception, where inhibition of ovulation is not the primary mode of action (minipill) is not accepted as a highly effective method.
e These methods are only considered highly effective and therefore acceptable when used in conjunction with a barrier method (i.e., diaphragm with spermicide, sponge with spermicide, cervical cap with spermicide, condoms, spermicide alone.)
- Willing to forgo other immunomodulatory therapies (investigational or otherwise) for NMDAR encephalitis during the study.
Participant must have received at least 3 days of methylprednisolone 1000 mg IV or equivalent corticosteroid within 90 days prior to randomization (Day 1). In addition, participants must have received EITHER of the following treatments within 90 days before randomization.
- IVIg, at a dose range between 1.2 and 2 g/kg
- Plasma exchange or plasmapheresis, (defined as 5 to 6 exchanges).
NOTE: These treatments may be provided during the screening period but must be completed prior to randomization. Participants who receive methylprednisolone and BOTH IVIg and plasma exchange are not excluded from participating in the trial, however, this treatment course with both IVIg and plasma exchange is not encouraged, and enrollment and randomization should not be delayed in order to complete additional first line treatments.
- Modified Rankin Score of ≥3 at the screening visit, indicating at least moderate disability. The baseline mRS must be confirmed by Site Investigators at screening and confirmed / adjudicated before randomization.
- Ability and willingness to attend study visits and complete the study. *All inclusion criteria must be met during the screening period, prior to randomization, except where noted.
Exclusion Criteria
Any of the following excludes an individual from participation in the study:
- Any condition that, in the opinion of the Investigator, would interfere with the evaluation or administration of the IP, interpretation of participant safety or study results, or would make participation in the study an unacceptable risk. This specifically includes recent history (last 5 years) of herpes simplex virus encephalitis or known central nervous system demyelinating disease (e.g., multiple sclerosis).
- Presence of an active or chronic infection that is serious in the opinion of the Investigator.
- History of solid organ or cell-based transplantation.
- Concurrent/previous enrollment in another clinical study involving an investigational treatment within 4 weeks or 5 published half-lives of the investigational treatment, whichever is longer, prior to randomization.
- Lactating or pregnant individuals, or individuals who intend to become pregnant anytime from study enrollment to 12 months following last dose of investigational agent.
- Known history of allergy or reaction to any component of the investigational agent formulation or history of anaphylaxis following any biologic therapy.
Receipt of the following at any time prior to randomization:
a. Alemtuzumab b. Total lymphoid irradiation c. Bone marrow transplant d. T-cell vaccination therapy
- Receipt of any biologic B cell-depleting therapy (e.g., rituximab, ocrelizumab, obinutuzumab, ofatumumab, inebilizumab) in the 6 months prior to screening. Receipt of such a B cell-depleting agent in the period 6-12 months prior to screening is exclusionary unless B cell counts have returned to ≥ age-based LLN by central laboratory. For EU participants, B cell counts at screening will be determined by the laboratories of the participating sites. Receipt of non-depleting B cell-directed therapy (e.g., belimumab), abatacept, or other biologic immunomodulatory agent within 6 months prior screening.
Treatment at therapeutic doses/durations with any of the following within 3 months prior to randomization
a. Natalizumab (Tysabri®) b. Cyclosporine c. Methotrexate d. Mitoxantrone e. Cyclophosphamide* f. Azathioprine g. Mycophenolate mofetil
*Cyclophosphamide is only permitted as rescue therapy to be administered as outlined in Section 5.4.1 no earlier than the week 6 visit.
- Severe drug allergic history or anaphylaxis to two or more food products or medicines (including known sensitivity to acetaminophen/paracetamol, diphenhydramine (cetirizine in EU) or equivalent antihistamine, and methylprednisolone or equivalent glucocorticoid).
- Known history of a primary immunodeficiency (congenital or acquired) or an underlying condition such as human immunodeficiency virus (HIV) infection or splenectomy that predisposes the participant to infection.
- Active malignancy or history of malignancy that was active within the last 10 years, apart from ovarian or extra-ovarian teratoma (also known as a dermoid cyst) or germ cell tumor, or squamous cell carcinoma of the skin or basal cell carcinoma of the skin, that in the opinion of the Medical Safety Monitor (MSM) would preclude enrollment due to safety concerns. Squamous cell and basal cell carcinomas should be treated with documented success of curative therapy > 3 months prior to randomization.
At screening (repeat testing may be conducted to confirm results within the same screening period, prior to randomization), any of the following:
a. Total white blood count <2,500 cells/mm3 (or < 2.5 × 109/L) b. Total immunoglobulin < 600 mg/dL (or 6 µmol/L; 400 mg/dL for participants <18 years)* c. Absolute neutrophil count < 1200 cells/μL (or < 1.2 × 109/L) d. CD4 T lymphocyte count < 300 cells/µL (or < 0.3 × 109/L)
*Baseline levels of IgG prior to first line treatments (methylprednisolone, plasmapheresis/plasma exchange) should be used to determine eligibility.
- Active hepatitis B or C established with positive hepatitis B serology (hepatitis B surface antigen and core antigen) and/or positive hepatitis C PCR testing and confirmed by the MSM
- Any live or attenuated vaccine within 4 weeks prior to Day 1 (administration of killed vaccines is acceptable).
- Bacillus of Calmette and Guérin (BCG) vaccine within 1 year of enrollment.
- History of alcohol or drug abuse that, in the opinion of the Investigator, might affect participant safety or compliance with visits or interfere with safety or other study assessments.
- Recurrence of previously treated NMDAR encephalitis within the last 5 years, or suspicion of symptomatic untreated NMDAR encephalitis of greater than 3 months duration at the time of screening.
Evidence of active tuberculosis* (TB) or being at high risk for TB based on:
a. History of active TB or untreated/incompletely treated latent TB. Participants with a history of active or latent TB who have documentation of completion of treatment according to local guidelines may be enrolled.
b. History of recent (≤ 12 weeks of screening) close contact with someone with active TB (close contact is defined as ≥ 4 hours/week OR living in the same household OR in a house where a person with active TB is a frequent visitor).
c. Signs or symptoms that could represent active TB by medical history or physical examination.
d. Positive, indeterminate, or invalid interferon-gamma release assay test result at screening, unless previously treated for TB. Participants with an indeterminate test result can repeat the test once, but if the repeat test is also indeterminate, the participant is excluded.
e. Chest radiograph, chest computed tomography or MRI scan that suggests a possible diagnosis of TB or suggests that a work-up for TB should be considered; all participants must have had lung imaging with an acceptable reading within 6 months prior to consent, or during screening.
- Active, clinically significant (CS) infection at the time of randomization (IP administration may be delayed until recovery, if within 14-day screening window, otherwise participant may be rescreened).
Exclusion criteria are applied at time of screening and are applicable throughout the study.
- Participants will undergo QuantiFERON®-TB Gold testing or equivalent TB testing during screening as standard of care. A positive result will not exclude patients from participation; thus, enrollment should not be delayed awaiting this result. If positive, an appropriate course of anti-TB treatment will need to be documented. If results are in indeterminate, participants may still be eligible for randomization if history is not suggestive of active / latent TB and a chest x-ray shows no evidence of active or latent TB.
1.1 Additional Eligibility Considerations
The following criteria are not necessarily exclusionary but require review from the MSM to determine if a participant should be excluded due to safety concerns:
At screening (out of range lab values may be reviewed with the MSM to determine whether a potential participant should be excluded for safety reasons; repeat testing may be conducted to confirm results within the same screening period, prior to randomization), any of the following:
- Aspartate transaminase (AST) > 2.5 × age-based upper limit of normal (ULN)
- Alanine transaminase (ALT) > 2.5 × age-based ULN
- Total bilirubin > 1.5 × age-based ULN (unless due to Gilbert's syndrome)
- Platelet count < 75,000/μL (or < 75 × 109/L)
- Hemoglobin < 8 g/dL (or < 80 g/L or 5 mmol/L)
- History of untreated hepatitis C infection. Participants who are considered cured following antiviral therapy with an HCV load below the limit of detection may be enrolled pending confirmation from the MSM that there are no safety concerns for inclusion.
- Patients with coexistent autoantibodies should not immediately be excluded but should be reviewed with the MSM to determine eligibility.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Active Comparator: Inebilizumab
Approximately 58 patients will receive Inebilizumab in addition to first line immunotherapy. (Approximately 116 participants will be randomized in a 1:1 ratio to 2 treatment groups; approximately 58 participants to each treatment group). All participants will also receive a 3 day course of IVIg. |
RCP: Blinded treatment on Day 1, Day 15,
Rescue therapy will be given to participants in either treatment group based on the results of the Week 6 assessments. Rescue therapy is cyclophosphamide 750 mg/m2 IV followed by additional doses every 28-30 days until the mRS score is ≤ 3 (at site Principal Investigator's discretion under standard of care).
Other Names:
|
|
Placebo Comparator: Placebo
Approximately 58 patients will receive placebo in addition to first line immunotherapy. (Approximately 116 participants will be randomized in a 1:1 ratio to 2 treatment groups; approximately 58 participants to each treatment group). All participants will also receive a 3 day course of IVIg. |
The placebo group will receive IV matching placebo on Day 1 and Day 15,
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Change of modified Rankin score at 16 weeks
Time Frame: 16 weeks
|
Change in modified Rankin score (mRS) (0 to 6; 0=normal and 6=death) at 16 weeks determined by rank analyses, integrating need for rescue therapy and time to achievement of the mRS.
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16 weeks
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Inebilizumab safety measures by the number of treatment-emergent adverse events and serious adverse events
Time Frame: 96 weeks
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Inebilizumab safety, as measured by the number of treatment-emergent adverse events (TEAEs) and treatment-emergent serious adverse events (TESAEs)
|
96 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Time to mRS ≤ 2, corrected for baseline value.
Time Frame: 96 weeks
|
Time to mRS ≤ 2, corrected for baseline value.
|
96 weeks
|
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Clinical Assessment Scale in Autoimmune Encephalitis (CASE) Score (continuous logistic regression), corrected from baseline value to week 24 (weeks 6 and 16).
Time Frame: 16 weeks
|
Clinical Assessment Scale in Autoimmune Encephalitis (CASE) Score (ranges of 0 to 27 with 0 being normal and 27 being worse)(continuous logistic regression), corrected from baseline value to week 24 (weeks 6 and 16).
|
16 weeks
|
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mRS at week 6 as measured by proportional odds logistic regression/shift analysis.
Time Frame: 6 weeks
|
mRS at week 6 as measured by proportional odds logistic regression/shift analysis.
|
6 weeks
|
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Proportion of participants who meet the protocol-defined criteria for needing rescue therapy at week 6.
Time Frame: 6 weeks
|
Proportion of participants who meet the protocol-defined criteria for needing rescue therapy at week 6.
|
6 weeks
|
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Cognitive outcome at week 24 as measured by mean scaled score on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) + components of Delis-Kaplan Executive Function System (D-KEFS).
Time Frame: 24 weeks
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Cognitive outcome at week 24 as measured by mean scaled score on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) + components of Delis-Kaplan Executive Function System (D-KEFS).
|
24 weeks
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Survival as measured by a Kaplan-Meier analysis.
Time Frame: 96 weeks
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Survival as measured by a Kaplan-Meier analysis.
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96 weeks
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Stacey L Clardy, MD, PhD, University of Utah
Publications and helpful links
General Publications
- Titulaer MJ, McCracken L, Gabilondo I, Armangue T, Glaser C, Iizuka T, Honig LS, Benseler SM, Kawachi I, Martinez-Hernandez E, Aguilar E, Gresa-Arribas N, Ryan-Florance N, Torrents A, Saiz A, Rosenfeld MR, Balice-Gordon R, Graus F, Dalmau J. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol. 2013 Feb;12(2):157-65. doi: 10.1016/S1474-4422(12)70310-1. Epub 2013 Jan 3.
- Gabilondo I, Saiz A, Galan L, Gonzalez V, Jadraque R, Sabater L, Sans A, Sempere A, Vela A, Villalobos F, Vinals M, Villoslada P, Graus F. Analysis of relapses in anti-NMDAR encephalitis. Neurology. 2011 Sep 6;77(10):996-9. doi: 10.1212/WNL.0b013e31822cfc6b. Epub 2011 Aug 24.
- Dalmau J, Tuzun E, Wu HY, Masjuan J, Rossi JE, Voloschin A, Baehring JM, Shimazaki H, Koide R, King D, Mason W, Sansing LH, Dichter MA, Rosenfeld MR, Lynch DR. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007 Jan;61(1):25-36. doi: 10.1002/ana.21050.
- Dubey D, Pittock SJ, Kelly CR, McKeon A, Lopez-Chiriboga AS, Lennon VA, Gadoth A, Smith CY, Bryant SC, Klein CJ, Aksamit AJ, Toledano M, Boeve BF, Tillema JM, Flanagan EP. Autoimmune encephalitis epidemiology and a comparison to infectious encephalitis. Ann Neurol. 2018 Jan;83(1):166-177. doi: 10.1002/ana.25131.
- Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M, Dessain SK, Rosenfeld MR, Balice-Gordon R, Lynch DR. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol. 2008 Dec;7(12):1091-8. doi: 10.1016/S1474-4422(08)70224-2. Epub 2008 Oct 11.
- Guasp M, Modena Y, Armangue T, Dalmau J, Graus F. Clinical features of seronegative, but CSF antibody-positive, anti-NMDA receptor encephalitis. Neurol Neuroimmunol Neuroinflamm. 2020 Jan 3;7(2):e659. doi: 10.1212/NXI.0000000000000659. Print 2020 Mar.
- Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2011 Jan;10(1):63-74. doi: 10.1016/S1474-4422(10)70253-2.
- Cree BAC, Bennett JL, Kim HJ, Weinshenker BG, Pittock SJ, Wingerchuk DM, Fujihara K, Paul F, Cutter GR, Marignier R, Green AJ, Aktas O, Hartung HP, Lublin FD, Drappa J, Barron G, Madani S, Ratchford JN, She D, Cimbora D, Katz E; N-MOmentum study investigators. Inebilizumab for the treatment of neuromyelitis optica spectrum disorder (N-MOmentum): a double-blind, randomised placebo-controlled phase 2/3 trial. Lancet. 2019 Oct 12;394(10206):1352-1363. doi: 10.1016/S0140-6736(19)31817-3. Epub 2019 Sep 5.
- Hara M, Martinez-Hernandez E, Arino H, Armangue T, Spatola M, Petit-Pedrol M, Saiz A, Rosenfeld MR, Graus F, Dalmau J. Clinical and pathogenic significance of IgG, IgA, and IgM antibodies against the NMDA receptor. Neurology. 2018 Apr 17;90(16):e1386-e1394. doi: 10.1212/WNL.0000000000005329. Epub 2018 Mar 16.
- Warikoo N, Brunwasser SJ, Benz A, Shu HJ, Paul SM, Lewis M, Doherty J, Quirk M, Piccio L, Zorumski CF, Day GS, Mennerick S. Positive Allosteric Modulation as a Potential Therapeutic Strategy in Anti-NMDA Receptor Encephalitis. J Neurosci. 2018 Mar 28;38(13):3218-3229. doi: 10.1523/JNEUROSCI.3377-17.2018. Epub 2018 Feb 23.
- Hughes EG, Peng X, Gleichman AJ, Lai M, Zhou L, Tsou R, Parsons TD, Lynch DR, Dalmau J, Balice-Gordon RJ. Cellular and synaptic mechanisms of anti-NMDA receptor encephalitis. J Neurosci. 2010 Apr 28;30(17):5866-75. doi: 10.1523/JNEUROSCI.0167-10.2010.
- Tuzun E, Zhou L, Baehring JM, Bannykh S, Rosenfeld MR, Dalmau J. Evidence for antibody-mediated pathogenesis in anti-NMDAR encephalitis associated with ovarian teratoma. Acta Neuropathol. 2009 Dec;118(6):737-43. doi: 10.1007/s00401-009-0582-4.
- Matute C, Palma A, Serrano-Regal MP, Maudes E, Barman S, Sanchez-Gomez MV, Domercq M, Goebels N, Dalmau J. N-Methyl-D-Aspartate Receptor Antibodies in Autoimmune Encephalopathy Alter Oligodendrocyte Function. Ann Neurol. 2020 May;87(5):670-676. doi: 10.1002/ana.25699. Epub 2020 Feb 24.
- Planaguma J, Leypoldt F, Mannara F, Gutierrez-Cuesta J, Martin-Garcia E, Aguilar E, Titulaer MJ, Petit-Pedrol M, Jain A, Balice-Gordon R, Lakadamyali M, Graus F, Maldonado R, Dalmau J. Human N-methyl D-aspartate receptor antibodies alter memory and behaviour in mice. Brain. 2015 Jan;138(Pt 1):94-109. doi: 10.1093/brain/awu310. Epub 2014 Nov 11.
- Planaguma J, Haselmann H, Mannara F, Petit-Pedrol M, Grunewald B, Aguilar E, Ropke L, Martin-Garcia E, Titulaer MJ, Jercog P, Graus F, Maldonado R, Geis C, Dalmau J. Ephrin-B2 prevents N-methyl-D-aspartate receptor antibody effects on memory and neuroplasticity. Ann Neurol. 2016 Sep;80(3):388-400. doi: 10.1002/ana.24721. Epub 2016 Aug 2.
- Malviya M, Barman S, Golombeck KS, Planaguma J, Mannara F, Strutz-Seebohm N, Wrzos C, Demir F, Baksmeier C, Steckel J, Falk KK, Gross CC, Kovac S, Bonte K, Johnen A, Wandinger KP, Martin-Garcia E, Becker AJ, Elger CE, Klocker N, Wiendl H, Meuth SG, Hartung HP, Seebohm G, Leypoldt F, Maldonado R, Stadelmann C, Dalmau J, Melzer N, Goebels N. NMDAR encephalitis: passive transfer from man to mouse by a recombinant antibody. Ann Clin Transl Neurol. 2017 Oct 3;4(11):768-783. doi: 10.1002/acn3.444. eCollection 2017 Nov.
- Jones BE, Tovar KR, Goehring A, Jalali-Yazdi F, Okada NJ, Gouaux E, Westbrook GL. Autoimmune receptor encephalitis in mice induced by active immunization with conformationally stabilized holoreceptors. Sci Transl Med. 2019 Jul 10;11(500):eaaw0044. doi: 10.1126/scitranslmed.aaw0044.
- Rubenstein JL, Combs D, Rosenberg J, Levy A, McDermott M, Damon L, Ignoffo R, Aldape K, Shen A, Lee D, Grillo-Lopez A, Shuman MA. Rituximab therapy for CNS lymphomas: targeting the leptomeningeal compartment. Blood. 2003 Jan 15;101(2):466-8. doi: 10.1182/blood-2002-06-1636. Epub 2002 Sep 5.
- Muldoon LL, Soussain C, Jahnke K, Johanson C, Siegal T, Smith QR, Hall WA, Hynynen K, Senter PD, Peereboom DM, Neuwelt EA. Chemotherapy delivery issues in central nervous system malignancy: a reality check. J Clin Oncol. 2007 Jun 1;25(16):2295-305. doi: 10.1200/JCO.2006.09.9861.
- Mei HE, Frolich D, Giesecke C, Loddenkemper C, Reiter K, Schmidt S, Feist E, Daridon C, Tony HP, Radbruch A, Dorner T. Steady-state generation of mucosal IgA+ plasmablasts is not abrogated by B-cell depletion therapy with rituximab. Blood. 2010 Dec 9;116(24):5181-90. doi: 10.1182/blood-2010-01-266536. Epub 2010 Sep 9.
- Makuch M, Wilson R, Al-Diwani A, Varley J, Kienzler AK, Taylor J, Berretta A, Fowler D, Lennox B, Leite MI, Waters P, Irani SR. N-methyl-D-aspartate receptor antibody production from germinal center reactions: Therapeutic implications. Ann Neurol. 2018 Mar;83(3):553-561. doi: 10.1002/ana.25173.
- Chen D, Gallagher S, Monson NL, Herbst R, Wang Y. Inebilizumab, a B Cell-Depleting Anti-CD19 Antibody for the Treatment of Autoimmune Neurological Diseases: Insights from Preclinical Studies. J Clin Med. 2016 Nov 24;5(12):107. doi: 10.3390/jcm5120107.
- Sanz I. Rationale for B cell targeting in SLE. Semin Immunopathol. 2014 May;36(3):365-75. doi: 10.1007/s00281-014-0430-z. Epub 2014 Apr 25.
- Halliley JL, Tipton CM, Liesveld J, Rosenberg AF, Darce J, Gregoretti IV, Popova L, Kaminiski D, Fucile CF, Albizua I, Kyu S, Chiang KY, Bradley KT, Burack R, Slifka M, Hammarlund E, Wu H, Zhao L, Walsh EE, Falsey AR, Randall TD, Cheung WC, Sanz I, Lee FE. Long-Lived Plasma Cells Are Contained within the CD19(-)CD38(hi)CD138(+) Subset in Human Bone Marrow. Immunity. 2015 Jul 21;43(1):132-45. doi: 10.1016/j.immuni.2015.06.016. Epub 2015 Jul 14.
- Mei HE, Wirries I, Frolich D, Brisslert M, Giesecke C, Grun JR, Alexander T, Schmidt S, Luda K, Kuhl AA, Engelmann R, Durr M, Scheel T, Bokarewa M, Perka C, Radbruch A, Dorner T. A unique population of IgG-expressing plasma cells lacking CD19 is enriched in human bone marrow. Blood. 2015 Mar 12;125(11):1739-48. doi: 10.1182/blood-2014-02-555169. Epub 2015 Jan 8.
- Schuh E, Berer K, Mulazzani M, Feil K, Meinl I, Lahm H, Krane M, Lange R, Pfannes K, Subklewe M, Gurkov R, Bradl M, Hohlfeld R, Kumpfel T, Meinl E, Krumbholz M. Features of Human CD3+CD20+ T Cells. J Immunol. 2016 Aug 15;197(4):1111-7. doi: 10.4049/jimmunol.1600089. Epub 2016 Jul 13.
- Agius MA, Klodowska-Duda G, Maciejowski M, Potemkowski A, Li J, Patra K, Wesley J, Madani S, Barron G, Katz E, Flor A. Safety and tolerability of inebilizumab (MEDI-551), an anti-CD19 monoclonal antibody, in patients with relapsing forms of multiple sclerosis: Results from a phase 1 randomised, placebo-controlled, escalating intravenous and subcutaneous dose study. Mult Scler. 2019 Feb;25(2):235-245. doi: 10.1177/1352458517740641. Epub 2017 Nov 16.
- Schiopu E, Chatterjee S, Hsu V, Flor A, Cimbora D, Patra K, Yao W, Li J, Streicher K, McKeever K, White B, Katz E, Drappa J, Sweeny S, Herbst R. Safety and tolerability of an anti-CD19 monoclonal antibody, MEDI-551, in subjects with systemic sclerosis: a phase I, randomized, placebo-controlled, escalating single-dose study. Arthritis Res Ther. 2016 Jun 7;18(1):131. doi: 10.1186/s13075-016-1021-2.
- Streicher K, Sridhar S, Kuziora M, Morehouse CA, Higgs BW, Sebastian Y, Groves CJ, Pilataxi F, Brohawn PZ, Herbst R, Ranade K. Baseline Plasma Cell Gene Signature Predicts Improvement in Systemic Sclerosis Skin Scores Following Treatment With Inebilizumab (MEDI-551) and Correlates With Disease Activity in Systemic Lupus Erythematosus and Chronic Obstructive Pulmonary Disease. Arthritis Rheumatol. 2018 Dec;70(12):2087-2095. doi: 10.1002/art.40656. Epub 2018 Oct 22.
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- Balu R, McCracken L, Lancaster E, Graus F, Dalmau J, Titulaer MJ. A score that predicts 1-year functional status in patients with anti-NMDA receptor encephalitis. Neurology. 2019 Jan 15;92(3):e244-e252. doi: 10.1212/WNL.0000000000006783. Epub 2018 Dec 21.
- Lim JA, Lee ST, Moon J, Jun JS, Kim TJ, Shin YW, Abdullah S, Byun JI, Sunwoo JS, Kim KT, Yang TW, Lee WJ, Moon HJ, Kim DW, Lim BC, Cho YW, Yang TH, Kim HJ, Kim YS, Koo YS, Park B, Jung KH, Kim M, Park KI, Jung KY, Chu K, Lee SK. Development of the clinical assessment scale in autoimmune encephalitis. Ann Neurol. 2019 Mar;85(3):352-358. doi: 10.1002/ana.25421. Epub 2019 Feb 10.
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- Gresa-Arribas N, Titulaer MJ, Torrents A, Aguilar E, McCracken L, Leypoldt F, Gleichman AJ, Balice-Gordon R, Rosenfeld MR, Lynch D, Graus F, Dalmau J. Antibody titres at diagnosis and during follow-up of anti-NMDA receptor encephalitis: a retrospective study. Lancet Neurol. 2014 Feb;13(2):167-77. doi: 10.1016/S1474-4422(13)70282-5. Epub 2013 Dec 18.
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Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 143461
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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