Comparison Between Rituximab Treatment for New-Onset Generalized Myasthenia Gravis and Refractory Generalized Myasthenia Gravis

Brauner, Susanna; Eriksson-Dufva, Ann; Hietala, Max Albert; Frisell, Thomas; Press, Rayomand; Piehl, Fredrik

doi:10.1001/jamaneurol.2020.0851

Cited by 83 publications

(94 citation statements)

References 41 publications

(79 reference statements)

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“…Rituximab has a role in patients presenting aggressively and explosively at onset and who are refractory to all conventional therapies. Brauner et al (114) demonstrated that clinical outcomes were better in patients who were treated early rather than later with Rituximab. There is scope for considering Rituximab in patients who are in crisis and who are not responding to high dose corticosteroids or ivIG or PE, and when patients demonstrate resistance in weaning off ventilation during the treatment pathway of MG crisis.…”

Section: The Refractory Mg Patient and Novel Therapiesmentioning

confidence: 99%

A Practical Approach to Managing Patients With Myasthenia Gravis—Opinions and a Review of the Literature

Farrugia

Goodfellow

2020

Front. Neurol.

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When the diagnosis of myasthenia gravis (MG) has been secured, the aim of management should be prompt symptom control and the induction of remission or minimal manifestations. Symptom control, with acetylcholinesterase inhibitors such as pyridostigmine, is commonly employed. This may be sufficient in mild disease. There is no single universally accepted treatment regimen. Corticosteroids are the mainstay of immunosuppressive treatment in patients with more than mild MG to induce remission. Immunosuppressive therapies, such as azathioprine are prescribed in addition to but sometimes instead of corticosteroids when background comorbidities preclude or restrict the use of steroids. Rituximab has a role in refractory MG, while plasmapheresis and immunoglobulin therapy are commonly prescribed to treat MG crisis and in some cases of refractory MG. Data from the MGTX trial showed clear evidence that thymectomy is beneficial in patients with acetylcholine receptor (AChR) antibody positive generalized MG, up to the age of 65 years. Minimally invasive thymectomy surgery including robotic-assisted thymectomy surgery has further revolutionized thymectomy and the management of MG. Ocular MG is not life-threatening but can be significantly disabling when diplopia is persistent. There is evidence to support early treatment with corticosteroids when ocular motility is abnormal and fails to respond to symptomatic treatment. Treatment needs to be individualized in the older age-group depending on specific comorbidities. In the younger age-groups, particularly in women, consideration must be given to the potential teratogenicity of certain therapies. Novel therapies are being developed and trialed, including ones that inhibit complement-induced immunological pathways or interfere with antibody-recycling pathways. Fatigue is common in MG and should be duly identified from fatigable weakness and managed with a combination of physical therapy with or without psychological support. MG patients may also develop dysfunctional breathing and the necessary respiratory physiotherapy techniques need to be implemented to alleviate the patient's symptoms of dyspnoea. In this review, we discuss various facets of myasthenia management in adults with ocular Farrugia and Goodfellow Practical Approaches to Myasthenia Management and generalized disease, including some practical approaches and our personal opinions based on our experience.

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Section: The Refractory Mg Patient and Novel Therapiesmentioning

confidence: 99%

A Practical Approach to Managing Patients With Myasthenia Gravis—Opinions and a Review of the Literature

Farrugia

Goodfellow

2020

Front. Neurol.

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“…The most common MG evaluation scores are manual muscle testing (MMT), quantitative MG (QMG) score, MGFA-PIS, and MGCS. Due to the nature of our study, we used the MGCS, which evaluates only clinical parameters [11][12][13].…”

Section: Discussionmentioning

confidence: 99%

Rituximab in Refractory Myasthenia Gravis: Experience in a Single Healthcare Center in Mexico

López-Hernández¹,

Galnares-Olalde²,

Gómez‐Figueroa³

et al. 2021

Cureus

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“…Remission was more frequent in MuSK positive patients than in AChRab positive patients (71 vs. 36%) ( 72 ). Another recent retrospective review from Stockholm showed that rituximab shortened the time to remission and the need for additional immunosuppressive therapies in patients with new-onset MG treated within 12 months after diagnosis, compared to the longer time for remission in those with refractory disease ( 73 ). The time to remission was shorter with rituximab compared to those who received other immunosuppressive therapy.…”

Section: Direct B Cell Depletorsmentioning

confidence: 99%

Novel Treatments in Myasthenia Gravis

2020

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Myasthenia gravis (MG) is the prototypical autoimmune disorder caused by specific autoantibodies at the neuromuscular junction. Broad-based immunotherapies, such as corticosteroids, azathioprine, mycophenolate, tacrolimus, and cyclosporine, have been effective in controlling symptoms of myasthenia. While being effective in a majority of MG patients many of these immunosuppressive agents are associated with long-term side effects, often intolerable for patients, and take several months to be effective. With advances in translational research and drug development capabilities, more directed therapeutic agents that can alter the future of MG treatment have been developed. This review focuses on the aberrant immunological processes in MG, the novel agents that target them along with the clinical evidence for efficacy and safety. These agents include terminal complement C5 inhibitors, Fc receptor inhibitors, B cell depleting agents (anti CD 19 and 20 and B cell activating factor [BAFF)]inhibitors), proteosome inhibitors, T cells and cytokine based therapies (chimeric antigen receptor T [CART-T] cell therapy), autologous stem cell transplantation, and subcutaneous immunoglobulin (SCIG). Most of these new agents have advantages over conventional immunosuppressive treatment (IST) for MG therapy in terms of faster onset of action, favourable side effect profile and the potential for a sustained and long-term remission.

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Comparison Between Rituximab Treatment for New-Onset Generalized Myasthenia Gravis and Refractory Generalized Myasthenia Gravis

Cited by 83 publications

References 41 publications

A Practical Approach to Managing Patients With Myasthenia Gravis—Opinions and a Review of the Literature

A Practical Approach to Managing Patients With Myasthenia Gravis—Opinions and a Review of the Literature

Rituximab in Refractory Myasthenia Gravis: Experience in a Single Healthcare Center in Mexico

Novel Treatments in Myasthenia Gravis

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