Refractory myasthenia gravis – clinical profile, comorbidities and response to rituximab

Autoantibody profile in myasthenia gravis patients with a refractory phase

“…Previous articles report a lower percent of double seronegativity among refractory MG patients that ranges from 0% to 21%. [2][3][4] However, in accordance with our findings, Rath et al 4 reported that 33.3% of DSNMG and 9.1% of AChR-positive patients developed refractory MG; our percentages were 27.3% and 11.4%, respectively. Not surprisingly, antibodies against LRP4 were not present in any of the DSNMG refractory patients, because LRP4-positive patients tend to respond well to standard MG therapy.…”

Autoantibody profile in myasthenia gravis patients with a refractory phase

“…Previous articles report a lower percent of double seronegativity among refractory MG patients that ranges from 0% to 21%. [2][3][4] However, in accordance with our findings, Rath et al 4 reported that 33.3% of DSNMG and 9.1% of AChR-positive patients developed refractory MG; our percentages were 27.3% and 11.4%, respectively. Not surprisingly, antibodies against LRP4 were not present in any of the DSNMG refractory patients, because LRP4-positive patients tend to respond well to standard MG therapy.…”

Performance of different criteria for refractory myasthenia gravis

“…Therefore, Across all criteria there were a higher proportion of women, MuSK antibody positivity, and longer mean disease duration in refractory patients (Table 2). This trend has been reported in various other refractory MG studies [4,5,15]. Interestingly, neither the ICG or REGAIN criteria resulted in patients with pure ocular disease classified as refractory.…”

“…In this cohort of individuals with MG, we found a wide variability in the proportion of refractory cases according to the definition used. Previous literature has reported a prevalence of refractory MG between 10%-20% of the general MG population [3][4][5][6][7]. In this cohort we found rates beyond those numbers (i.e., less than 10% and up to 40%), this is not surprising considering the differences between criteria.…”

Effects of rituximab on prognosis in myasthenia gravis: A single-center experience from Turkey

“…In a study that included refractory AChR-Ab+ MG patients where RTX treatment was effective, no statistically significant differences were detected between pre-RTX and post-RTX antibody AChR-Ab titers 26 . It was found in some studies reported in the literature that antibody titers decreased after RTX treatment, which may be related to the response to treatment 21,27,28 . However, it was also found that titers did not rise at the time of recurrence 27 .…”

Autoantibody profile in myasthenia gravis patients with a refractory phase

“…Previous articles report a lower percent of double seronegativity among refractory MG patients that ranges from 0% to 21%. [2][3][4] However, in accordance with our findings, Rath et al 4 reported that 33.3% of DSNMG and 9.1% of AChR-positive patients developed refractory MG; our percentages were 27.3% and 11.4%, respectively. Not surprisingly, antibodies against LRP4 were not present in any of the DSNMG refractory patients, because LRP4-positive patients tend to respond well to standard MG therapy.…”

Performance of different criteria for refractory myasthenia gravis

“…Therefore, Across all criteria there were a higher proportion of women, MuSK antibody positivity, and longer mean disease duration in refractory patients (Table 2). This trend has been reported in various other refractory MG studies [4,5,15]. Interestingly, neither the ICG or REGAIN criteria resulted in patients with pure ocular disease classified as refractory.…”

“…In this cohort of individuals with MG, we found a wide variability in the proportion of refractory cases according to the definition used. Previous literature has reported a prevalence of refractory MG between 10%-20% of the general MG population [3][4][5][6][7]. In this cohort we found rates beyond those numbers (i.e., less than 10% and up to 40%), this is not surprising considering the differences between criteria.…”

Effects of rituximab on prognosis in myasthenia gravis: A single-center experience from Turkey

“…In a study that included refractory AChR-Ab+ MG patients where RTX treatment was effective, no statistically significant differences were detected between pre-RTX and post-RTX antibody AChR-Ab titers 26 . It was found in some studies reported in the literature that antibody titers decreased after RTX treatment, which may be related to the response to treatment 21,27,28 . However, it was also found that titers did not rise at the time of recurrence 27 .…”

Autoantibody profile in myasthenia gravis patients with a refractory phase

“…Previous articles report a lower percent of double seronegativity among refractory MG patients that ranges from 0% to 21%. [2][3][4] However, in accordance with our findings, Rath et al 4 reported that 33.3% of DSNMG and 9.1% of AChR-positive patients developed refractory MG; our percentages were 27.3% and 11.4%, respectively. Not surprisingly, antibodies against LRP4 were not present in any of the DSNMG refractory patients, because LRP4-positive patients tend to respond well to standard MG therapy.…”

Performance of different criteria for refractory myasthenia gravis

“…Therefore, Across all criteria there were a higher proportion of women, MuSK antibody positivity, and longer mean disease duration in refractory patients (Table 2). This trend has been reported in various other refractory MG studies [4,5,15]. Interestingly, neither the ICG or REGAIN criteria resulted in patients with pure ocular disease classified as refractory.…”

“…In this cohort of individuals with MG, we found a wide variability in the proportion of refractory cases according to the definition used. Previous literature has reported a prevalence of refractory MG between 10%-20% of the general MG population [3][4][5][6][7]. In this cohort we found rates beyond those numbers (i.e., less than 10% and up to 40%), this is not surprising considering the differences between criteria.…”

Effects of rituximab on prognosis in myasthenia gravis: A single-center experience from Turkey

“…In a study that included refractory AChR-Ab+ MG patients where RTX treatment was effective, no statistically significant differences were detected between pre-RTX and post-RTX antibody AChR-Ab titers 26 . It was found in some studies reported in the literature that antibody titers decreased after RTX treatment, which may be related to the response to treatment 21,27,28 . However, it was also found that titers did not rise at the time of recurrence 27 .…”