Journal
MUSCLE & NERVE
Volume 56, Issue 2, Pages 185-196Publisher
WILEY
DOI: 10.1002/mus.25597
Keywords
acetylcholine receptor antibody; B-cell depletion; muscle-specific tyrosine kinase; myasthenia gravis; rituximab
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Funding
- Genentech, Inc.
- General Clinical Research Centers of the National Institutes of Health [MO1-RR00109]
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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.
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