Predictors of response to rituximab in patients with neuropathy and anti-myelin associated glycoprotein immunoglobulin M.
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.
Benedetti
Luana
L
Department of Neurosciences, Ophthalmology and Genetics, University of Genova, Genova, Italy. luanabenedetti@libero.it
Briani
Chiara
C
Grandis
Marina
M
Vigo
Tiziana
T
Gobbi
Marco
M
Ghiglione
Elisabetta
E
Carpo
Marinella
M
Cocito
Dario
D
Caporale
Christina M
CM
Sormani
Maria P
MP
Mancardi
Giovanni L
GL
Nobile-Orazio
Eduardo
E
Schenone
Angelo
A
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
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