title: Predictors of response to rituximab in patients with neuropathy and anti-myelin associated glycoprotein immunoglobulin M.
abstract: We evaluated the efficacy and safety of rituximab in an open-label, uncontrolled study of 13 patients with polyneuropathy associated with antibodies to myelin-associated glycoprotein (MAG) and correlated the response to therapy with clinical and laboratory features. One year after rituximab therapy, anti-MAG immunoglobulin M (IgM) titers were significantly reduced. At that time, eight patients (62%) had improved in both the inflammatory neuropathy cause and treatment (INCAT) sensory sumscore and the Medical Research Council sumscore for muscle strength and seven of them also in the INCAT disability score. The improvement in the mean INCAT sensory sumscore was significant at 12 months and correlated with lower anti-MAG antibody at entry and at follow-up. This study suggests that rituximab may be efficacious in patients with anti-MAG associated neuropathy and particularly on sensory impairment and in those with moderately elevated antibody titers. These findings suggest that antibody reduction below a critical level may be necessary to achieve clinical improvement.
authors.affiliation: Department of Neurosciences, Ophthalmology and Genetics, University of Genova, Genova, Italy. luanabenedetti@libero.it
authors.forename: Luana
authors.initials: L
authors.lastname: Benedetti
authors.forename: Chiara
authors.initials: C
authors.lastname: Briani
authors.forename: Marina
authors.initials: M
authors.lastname: Grandis
authors.forename: Tiziana
authors.initials: T
authors.lastname: Vigo
authors.forename: Marco
authors.initials: M
authors.lastname: Gobbi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Ghiglione
authors.forename: Marinella
authors.initials: M
authors.lastname: Carpo
authors.forename: Dario
authors.initials: D
authors.lastname: Cocito
authors.forename: Christina M
authors.initials: CM
authors.lastname: Caporale
authors.forename: Maria P
authors.initials: MP
authors.lastname: Sormani
authors.forename: Giovanni L
authors.initials: GL
authors.lastname: Mancardi
authors.forename: Eduardo
authors.initials: E
authors.lastname: Nobile-Orazio
authors.forename: Angelo
authors.initials: A
authors.lastname: Schenone
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018941:Antigens, CD19 / Q000187:drug effects; D001323:Autoantibodies / Q000097:blood / Q000187:drug effects* / Q000276:immunology; D016175:B-Lymphocyte Subsets / Q000187:drug effects; D001402:B-Lymphocytes / Q000187:drug effects; D015153:Blotting, Western; D004576:Electromyography; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood / Q000187:drug effects / Q000276:immunology; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000187:drug effects; D018992:Myelin-Associated Glycoprotein / Q000276:immunology*; D009431:Neural Conduction / Q000187:drug effects; D011115:Polyneuropathies / Q000188:drug therapy* / Q000276:immunology; D000069283:Rituximab
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018941:Antigens, CD19; D001323:Autoantibodies; D007075:Immunoglobulin M; D007155:Immunologic Factors; D018992:Myelin-Associated Glycoprotein; D000069283:Rituximab