Rituximab treatment of myasthenia gravis: A systematic review.
Rituximab is a chimeric mouse/human anti-CD20 monoclonal immunoglobulin. We reviewed the efficacy and safety of rituximab in 169 myasthenia gravis (MG) patients from case reports and series. Antibodies to the acetylcholine receptor (AChR) were present in 59% and muscle-specific tyrosine kinase (MuSK) in 34%. Modified Myasthenia Gravis Foundation of America postintervention scale of minimal manifestations (MM) or better occurred in 44%, and combined pharmacologic and chronic stable remission in 27% overall; MM or better was achieved in 72% of MuSK MG and 30% of AChR MG (P < 0.001). Posttreatment relapses decreased more in MuSK MG (P = 0.05). Response predictors were MuSK MG, less severe disease, and younger age at treatment. Among a responder subset, 26% of AChR and 82% of MuSK MG patients showed decreased posttreatment antibody titers. Rituximab was generally well tolerated. Detectable serum rituximab and depleted CD20+B-cells were observed up to 20 and 16 weeks, respectively, after 4 weekly infusions. Muscle Nerve 56: 185-196, 2017.
Department of Neurological Sciences, University of Vermont, Robert Larner College of Medicine and University of Vermont Medical Center, Room 426, Health Sciences Research Facility, 149 Beaumont Avenue, Burlington, Vermont, 05405, USA.
Rup
R
Tandan
Department of Neurological Sciences, University of Vermont, Robert Larner College of Medicine and University of Vermont Medical Center, Room 426, Health Sciences Research Facility, 149 Beaumont Avenue, Burlington, Vermont, 05405, USA.
Michael K
MK
Hehir
Department of Neurological Sciences, University of Vermont, Robert Larner College of Medicine and University of Vermont Medical Center, Room 426, Health Sciences Research Facility, 149 Beaumont Avenue, Burlington, Vermont, 05405, USA.
Waqar
W
Waheed
Center for Clinical and Translational Science, University of Vermont, Robert Larner College of Medicine and University of Vermont Medical Center, Burlington, Vermont, USA.
Diantha B
DB
Howard
D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D009157:Myasthenia Gravis / Q000188:drug therapy* / Q000276:immunology; D000069283:Rituximab / Q000627:therapeutic use*
D007155:Immunologic Factors; D000069283:Rituximab
B-cell depletion; acetylcholine receptor antibody; muscle-specific tyrosine kinase; myasthenia gravis; rituximab