Resistant myasthenia gravis and rituximab: A monocentric retrospective study of 28 patients

Afanasiev, Vadim; Demeret, Sophie; Bolgert, Françis; Eymard, B.; Laforêt, Pascal; Benveniste, Olivier

doi:10.1016/j.nmd.2016.12.004

Cited by 46 publications

(48 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A recent meta‐analysis examined the effects of RTX in 169 MG patients, showing a good response as a postintervention status of minimal manifestations or better in 72% of MuSK + MG and 30% of AChR + MG patients . Results from this study and other recent reports are shown in Table …”

Section: Rtx In Mgsupporting

confidence: 68%

See 1 more Smart Citation

Rituximab in myasthenia gravis: a “to be or not to be” inhibitor of T cell function

Marino

Bartoccioni

Alboini

et al. 2018

Annals of the New York Academy of Sciences

View full text Add to dashboard Cite

In recent years, rituximab (RTX), a monoclonal antibody that binds the B lymphocyte membrane protein CD20, has been increasingly used for the treatment of autoimmune diseases, with the rationale of destroying pathogenic B lymphocytes and decreasing autoantibody formation. Surprisingly, RTX has also proven effective in predominantly T cell-mediated diseases, raising the question whether additional mechanisms may play roles in determining the therapeutic response. Here, we review the current literature on the effects of RTX in autoimmune diseases, with special emphasis on myasthenia gravis (MG). To elicit a complete and effective immune response, B and T lymphocytes cooperate in a loop in which they affect each other. Disruption of this cross talk has profound effects on the immune system. RTX is likely to affect the whole spectrum of B cell function, including antigen presentation, cytokine production, and T cell stimulation. In addition, as a small subset of T lymphocytes expresses CD20, its direct targeting by RTX may contribute to the therapeutic effect. Owing to its distinctive immune characteristics, MG proved to be a useful model to investigate the multifaceted implications of B cell depletion.

show abstract

Section: Rtx In Mgsupporting

confidence: 68%

“…Good response was defined as a postintervention status (PIS) of minimal manifestations or better, as a change in clinical scores, or as a change in both PIS and clinical scores …”

Section: Rtx In Mgmentioning

confidence: 99%

Rituximab in myasthenia gravis: a “to be or not to be” inhibitor of T cell function

Marino

Bartoccioni

Alboini

et al. 2018

Annals of the New York Academy of Sciences

View full text Add to dashboard Cite

show abstract

“…Treatment with rituximab is generally well tolerated. However, a few severe side effects have been reported in MG patients (e.g., myocardial infarction, spondylodiscitis, agranulocytosis, and two cases of progressive multifocal leukoencephalopathy). Prolonged B cell depletion has been observed in a patient with MuSK + MG .…”

Section: Therapymentioning

confidence: 99%

Myasthenia gravis with antibodies to MuSK: an update

Evoli

Alboini

Damato

et al. 2017

Annals of the New York Academy of Sciences

105

View full text Add to dashboard Cite

Myasthenia gravis with antibodies to the muscle-specific tyrosine kinase (MuSK MG) is a rare disease with distinctive pathogenic mechanisms and clinical features. An acute onset and predominant bulbar muscle weakness are very common and highly suggestive of the disease. On the other hand, a more indolent course, atypical ocular presentation, and signs of cholinergic hyperactivity may complicate the diagnosis. Though MuSK MG is still a severe disease, over the years we have observed a steady reduction in the rate of respiratory crisis and a significant improvement in the clinical outcome, both likely related to earlier diagnosis and timely treatment. Despite the improved management, MuSK MG patients tend to remain dependent on long-term immunosuppressive treatment and may develop permanent disabling weakness. In uncontrolled studies, B cell depletion with rituximab proved effective in most patients with refractory disease, inducing prolonged clinical responses associated with a sustained reduction of serum antibody levels. Promising results from experimental studies and case reports suggest that both 3,4-diaminopyridine and albuterol may be effective as symptomatic agents.

show abstract

“…Recently, rituximab, a chimeric monoclonal anti‐CD20 antibody that leads to depletion of circulating B cells, has shown promising results in treating refractory MG . Because CD20 is expressed at the start or the completion of B‐cell development, rituximab tends to deplete B cells without affecting the ability to produce new B cells or inhibit the production of antibodies by long‐lived plasma cells .…”

Section: Introductionmentioning

confidence: 99%

Low‐dose rituximab every 6 months for the treatment of acetylcholine receptor–positive refractory generalized myasthenia gravis

et al. 2020

View full text Add to dashboard Cite

Introduction In this prospective, open‐label study we explore the effectiveness of low‐dose rituximab every 6 months in treating refractory generalized myasthenia gravis (GMG). Methods Twelve patients with acetylcholine receptor (AChR)‐positive refractory GMG were enrolled for the study. The primary endpoint was the change in quantitative myasthenia gravis (QMG) score from baseline to the study end. Secondary endpoints included changes in manual muscle testing (MMT), MG‐Related Activities of Daily Living (MG‐ADL), and 15‐item Quality‐of‐Life (MGQOL‐15) scores, as well as prednisolone reduction. Results MG decreased from 18.25 ± 4.03 to 8.42 ± 3.99 (P = .0001), MMT from 27.50 ± 17.78 to 4.58 ± 4.34 (P = .0001), ADL from 8.50 ± 2.84 to 1.17 ± 1.27 (P < .0001), MGQOL‐15 from 37.25 ± 13.78 to 17.50 ± 9.73 (P = .0015), and prednisolone dose from 29.38 ± 11.92 mg/day to 8.86 ± 1.88 mg/day (P ≤ .01). Discussion Low‐dose rituximab every 6 months is effective in treating refractory GMG patients.

show abstract

Resistant myasthenia gravis and rituximab: A monocentric retrospective study of 28 patients

Cited by 46 publications

References 18 publications

Rituximab in myasthenia gravis: a “to be or not to be” inhibitor of T cell function

Rituximab in myasthenia gravis: a “to be or not to be” inhibitor of T cell function

Myasthenia gravis with antibodies to MuSK: an update

Low‐dose rituximab every 6 months for the treatment of acetylcholine receptor–positive refractory generalized myasthenia gravis

Contact Info

Product

Resources

About