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| First-line immunotherapies |
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| PLEX |
| Dosage: various numbers of plasma exchanges reported, typically 5 sessions of plasma exchange |
| Advantages: no long-term immunosuppressive effect |
| Disadvantages: requires large lumen intravascular indwelling catheter placement increasing chances for line sepsis and procedure-related complication and hemodynamic effect of PLEX can be detrimental in a patient with hypotension due to IVAD use |
| Corticosteroids |
| Dosage: various dose regimens reported in literature. Most commonly used regimen is IV methylprednisolone 1 g daily for 5 days followed by weekly single administration of 1 g for 4–6 weeks or conversion to oral prednisone 80 mg/day with a slow taper |
| Advantages: easily available, relatively inexpensive, and familiarity with the drug |
| Disadvantages: increases blood pressure, may increase vulnerability for infection, and may worsen hyperglycemia in patients with diabetes mellitus |
| IVIg |
| Dosage: 0.4 g/kg daily for 3–5 days and can be repeated weekly/monthly for 1–3 months |
| Advantages: no immunosuppressive effect |
| Disadvantages: allergy; increased volume load may worsen congestive heart failure; increased risk of thrombotic events such as deep vein thrombosis and pulmonary embolism and risk of renal function impairment especially in the presence of renal artery stenosis may cause aseptic meningitis presenting as headache and allergy |
| Second-line immunotherapies |
| Cyclophosphamide |
| Dosage: 750 mg/m2 |
| Advantages: well-known drug with a long track record which can be used by administrating monthly |
| Disadvantages: may not be immediately effective (suitable for maintenance therapy), may increase the risk of infections, has teratogenic potential, may increase the risk of future malignancy, and side effects include hemorrhagic cystitis, severe cardiotoxicity, alopecia, and nausea/vomiting |
| Rituximab |
| Dosage: most commonly used dose is 375 mg/m2 every week for 4 weeks |
| Advantages: usually well tolerated |
| Disadvantages: may not be immediately effective and may cause cytopenia, infusion reaction, potential for severe allergic reaction, renal failure, pregnancy, and hepatitis |
| Mycophenolate |
| Dosage: 250 mg–2 g per day (no standard dosing for autoimmune encephalitis) |
| Advantages: oral preparation for long-term use, usually well tolerated |
| Disadvantages: may not be immediately effective (suitable for maintenance therapy), needs oral administration, may be difficult in the ICU setting, may cause significant gastrointestinal side effects and hyperglycemia, and highly protein bound so may interact with AEDs that are protein bound |
| Azathioprine |
| Dosage: 1–3 mg/kg per day |
| Advantage: oral preparation for long-term use, usually well tolerated, and can be used as a steroid-sparing agent |
| Disadvantage: side effects such as elevated hepatic transaminases, leukopenia, pancreatitis, and immunosuppression |
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