title: Acute neurological worsening after Rituximab treatment in patients with anti-MAG neuropathy.
abstract: BACKGROUND
  Patients with peripheral neuropathy and anti-MAG monoclonal IgM may respond to Rituximab, a humanized monoclonal anti-CD20 antibody.
  
  
  METHODS
  We report on three patients with peripheral neuropathy and anti-MAG monoclonal IgM who deteriorated under Rituximab and reviewed seven previously published cases.
  
  
  RESULTS
  Worsening was acute and severe, and occurred during the treatment period. All the patients improved after deterioration but at final evaluation only one was improved comparatively to baseline, five were worsened and four were stabilized. Deterioration was not clearly associated with an increase of the anti-MAG antibody titer. Two patients received Rituximab prior or after the course which induced worsening without adverse reaction.
  
  
  CONCLUSIONS
  Although rare, acute worsening of the neuropathy can occur after Rituximab. The deterioration is however reversible within some weeks to several months.
authors.affiliation: Department of Neurology, University Hospital of Saint-Etienne, France; Reference Center for Rare Neuromuscular Diseases, University Hospital of Saint-Etienne, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Sala
authors.affiliation: Department of Neurology, University Hospital of Saint-Etienne, France; Reference Center for Rare Neuromuscular Diseases, University Hospital of Saint-Etienne, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Robert-Varvat
authors.affiliation: Laboratory of Immunology, University Hospital of Saint-Etienne, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Paul
authors.affiliation: Department of Neurology, University Hospital of Saint-Etienne, France; Reference Center for Rare Neuromuscular Diseases, University Hospital of Saint-Etienne, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Camdessanché
authors.affiliation: Department of Neurology, University Hospital of Saint-Etienne, France; Reference Center for Rare Neuromuscular Diseases, University Hospital of Saint-Etienne, France. Electronic address: j.christophe.antoine@chu-st-etienne.fr.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Antoine
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood*; D007155:Immunologic Factors / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D018992:Myelin-Associated Glycoprotein / Q000276:immunology*; D011115:Polyneuropathies / Q000188:drug therapy*; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007075:Immunoglobulin M; D007155:Immunologic Factors; D018992:Myelin-Associated Glycoprotein; D000069283:Rituximab
keywords: Anti-MAG antibody; Monoclonal gammopathy; Peripheral neuropathy; Rituximab; Side effect; Treatment