Remission with rituximab in refractory generalised myasthenia gravis

In a retrospective case series, rituximab was effective in refractory myasthenia gravis, either with anti-muscle-specific kinase (MuSK) or anti-acetylcholine receptor (AChR) autoantibodies. Early start of treatment may be associated with a more rapid and sustained clinical response.

Rituximab, a monoclonal antibody targeted against CD20, is a therapeutic option in myasthenia gravis, especially in refractory patients. In a single-centre study, 16 patients (13 females) with generalised myasthenia gravis who had been referred to a specialised clinic in Buenos Aires (Argentina) and were treated with rituximab were included [1]. Of the 16 participants, 8 had AChR and 8 had MuSK autoantibodies. Outcomes were assessed using the Myasthenia Gravis Status and Treatment Intensity (MGSTI) score. Patients received 2 immunosuppressants and had received at least one cycle of intravenous immunoglobulin. During induction, they received low-dose rituximab: 1,000 mg (n=7), 1,500 mg (n=2), or 2,000 mg (n=7); only 5 patients received maintenance doses. Follow-up data of a minimum of 2 years were available.

All 16 patients achieved and maintained undetectable CD20 levels at 6 and 12 months, without new relapses. All patients had MGSTI scores ≤2; the earlier rituximab treatment was initiated, the faster this score was reached.

1. Castiglione J, et al. Long-term remission with rituximab in refractory generalized myasthenia gravis. S12.001, AAN 2021 Virtual Congress, 17-22 April.

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