title: Refractory myasthenia gravis - clinical profile, comorbidities and response to rituximab.
abstract: Introduction:Myasthenia gravis (MG) is an antibody mediated autoimmune neuromuscular disorder characterized by fatigable muscle weakness. A proportion of myasthenia gravis patients are classified as refractory due to non responsiveness to conventional treatment. This retrospective study was done to evaluate clinical profile, epidemiological, laboratory, and features of patients with MG and mode of management using rituximab and complications.Methods:Data of myasthenia gravis patients admitted or presented to outpatient department (previous medical records) with MG between January 2008 and January 2016 were included. A total of 512 patients fulfilled the clinical and diagnostic criteria of myasthenia gravis of which 76 patients met the diagnostic certainty for refractory myasthenia gravis and were evaluated.Results:Out of 76 refractory MG patients, 53 (69.73%) patients fulfilled all the three defined criteria. The median age of onset of the refractory MG group was 36 years with a range of 27-53 years. In our study 25 patients (32.89%) belonged to the age group of 21-30 years. Anti-MuSK antibodies were positive in 8 non-refractory MG patients (2.06%) and 36 refractory MG patients (47.36%). Mean HbA1Cwas found to be 8.6±2.33. The dose of administered prednisone decreased by a mean of 59.7% (p=3.3x10-8) to 94.6% (p=2.2x10-14) after the third cycle of rituximab treatment.Conclusion:The refractory MG patients are most commonly female with an early age of onset, anti-MuSK antibodies, and thymomas. Refractory MG patients have higher prevalence and poor control (HbA1C>8%) of diabetes mellitus and dyslipidemia probably due to increased steroid usage. Rituximab is very efficient in treatment of refractory MG with adverse effects being low.
authors: Columbia Asia Hospital, Kirloskar Business Park, Hebbal, Bangalore, India.
authors: Sreenivasa Rao
authors: SR
authors: Sudulagunta
authors: Baptist Hospital, Bangalore, India.
authors: Mona
authors: M
authors: Sepehrar
authors: KS. Hegde Medical College, Mangalore, India.
authors: Mahesh Babu
authors: MB
authors: Sodalagunta
authors: Columbia Asia Hospital, Kirloskar Business Park, Hebbal, Bangalore, India.
authors: Aravinda
authors: A
authors: Settikere Nataraju
authors: Department of General Medicine, Dr.B.R.Ambedkar Medical College, Bangalore, India.
authors: Shiva Kumar
authors: SK
authors: Bangalore Raja
authors: Columbia Asia Hospital, Kirloskar Business Park, Hebbal, Bangalore, India.
authors: Deepak
authors: D
authors: Sathyanarayana
authors: Columbia Asia Hospital, Kirloskar Business Park, Hebbal, Bangalore, India.
authors: Siddharth
authors: S
authors: Gummadi
authors: Columbia Asia Hospital, Kirloskar Business Park, Hebbal, Bangalore, India.
authors: Hemanth Kumar
authors: HK
authors: Burra
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000906:Antibodies / Q000097:blood; D048909:Diabetes Complications / Q000097:blood / Q000150:complications; D003920:Diabetes Mellitus / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D011241:Prednisone / Q000008:administration & dosage; D020794:Receptor Protein-Tyrosine Kinases / Q000276:immunology; D019233:Retreatment; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use*; D013945:Thymoma / Q000150:complications*; D013953:Thymus Neoplasms / Q000150:complications*; D017211:Treatment Failure
chemical_list: D000893:Anti-Inflammatory Agents; D000906:Antibodies; D006442:Glycated Hemoglobin; D007155:Immunologic Factors; D011241:Prednisone; D020794:Receptor Protein-Tyrosine Kinases; D000069283:Rituximab; C517652:hemoglobin A1c protein, human
keywords: myasthenia gravis; refractory; rituximab