title: Sustained response to Rituximab in anti-AChR and anti-MuSK positive Myasthenia Gravis patients.
abstract: We report the results of treatment with Rituximab in six severe, non-responder MG patients. We treated three AChR+MG and three MuSK+MG patients, representing 2% and 20% of the respective groups of our series. Patients were assessed according to the Myasthenia Gravis Foundation of America (MGFA) recommendations. Antibody titers to AChR and MuSK, Ig levels, and IgG subclasses, were tested before treatment and during a follow-up of 9-22 months. All patients, one class V and five class IVB, improved dramatically, with no side effects. Antibody titers declined in all patients (p=0.006). The decline was significantly better in MuSK+MG patients at 9 months (p=0.046) and correlated with a more sustained clinical improvement. We did not find any significant changes in IgG4 that could explain the different outcome observed between these two groups.
authors.affiliation: Department of Neurology, Neuromuscular Unit, Hospital Santa Creu i Sant Pau, Universitat Autònoma Barcelona, Barcelona, Spain. iilla@santpau.es
authors.forename: Isabel
authors.initials: I
authors.lastname: Illa
authors.forename: Jordi
authors.initials: J
authors.lastname: Diaz-Manera
authors.forename: Ricard
authors.initials: R
authors.lastname: Rojas-Garcia
authors.forename: Jesus
authors.initials: J
authors.lastname: Pradas
authors.forename: Antonio
authors.initials: A
authors.lastname: Rey
authors.forename: Rafael
authors.initials: R
authors.lastname: Blesa
authors.forename: Candido
authors.initials: C
authors.lastname: Juarez
authors.forename: Eduard
authors.initials: E
authors.lastname: Gallardo
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000097:blood / Q000145:classification / Q000188:drug therapy* / Q000276:immunology; D020794:Receptor Protein-Tyrosine Kinases / Q000276:immunology*; D011950:Receptors, Cholinergic / Q000276:immunology*; D000069283:Rituximab; D018709:Statistics, Nonparametric
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007074:Immunoglobulin G; D007155:Immunologic Factors; D011950:Receptors, Cholinergic; D000069283:Rituximab; C095714:MUSK protein, human; D020794:Receptor Protein-Tyrosine Kinases