SynthesisJournal of neurology2025
Initiation of tocilizumab within 24 hours in acute necrotizing encephalopathy is related to a good outcome: a systematic review.
Synthesis in Journal of neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
3 citing papers in PubMed.
- Early Tocilizumab and Plasma Exchange Therapy for Influenza A-Associated Acute Necrotizing Encephalopathy.Indian journal of pediatrics · 2026Article
- Tocilizumab as a key therapeutic option in high-risk pediatric acute necrotizing encephalopathy.Clinical and experimental pediatrics · 2026Article
- Fatal hemorrhagic leukoencephalitis following VZV reactivation in an immunocompetent host: a case report.Journal of neurology · 2025Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
objectiveTo evaluate the clinical efficacy of tocilizumab, a interleukin-6 (IL-6) receptor blocker, for the treatment of acute necrotizing encephalopathy (ANE).
methodsPubMed, Cochrane Library, Embase, and Web of Science were searched for systematic review based on PRISMA guidelines. ANE patients treated with and without tocilizumab were included. Methodological quality was assessed independently by two authors. Data on clinical features, neuroimaging patterns and outcomes were analyzed.
resultsIn total, 77 cases from 21 studies were included. Most patients had fever and seizures. Respiratory viruses were common precipitating infection. All patients had bilateral thalamic lesions, and brainstem lesions were more frequently observed in the tocilizumab group (88.0% vs 64.0%, p = 0.04). The length of hospital stay was significantly longer in the tocilizumab group both before (p = 0.01) and after propensity score matching (PSM) (p = 0.02), while the mortality rate was significantly lower in tocilizumab compared with non-tocilizumab group (8.0% vs 33.3%, p = 0.02). Initiation of tocilizumab within 24 h was related to a good outcome both before (p < 0.01) and after PSM (p < 0.01). In multivariate regression analysis, elder age and < 24 h immunotherapy were independently related with good outcome (age: aOR = 1.35; 95% CI 1.06-1.74, p = 0.02; < 24 h immunotherapy: aOR = 8.60; 95% CI 1.08-68.63, p = 0.04). Brainstem lesions was an independent risk factor of poor outcome (aOR = 0.03; 95% CI 0.003-0.29, p < 0.01). Tocilizumab use was independently associated with reduced mortality (aOR = 7.95, 95%CI 1.47-43.03, p = 0.02). No adverse effects were reported.
conclusionThis review suggests that timely initiation of tocilizumab therapy within 24 h is safe, and may be an effective treatment in ANE, providing a strong rationale for a clinical trial.
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Registered trials
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