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Efficacy and safety of rituximab in myasthenia gravis: a French multicentre real‐life study
Author(s) -
Dos Santos A.,
Noury J. B.,
Genestet S.,
NadajPakleza A.,
Cassereau J.,
Baron C.,
Videt D.,
Michel L.,
Pereon Y.,
Wiertlewski S.,
Magot A.
Publication year - 2020
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.14391
Subject(s) - medicine , myasthenia gravis , rituximab , adverse effect , refractory (planetary science) , repetitive nerve stimulation , cytopenia , gastroenterology , anesthesia , lymphoma , bone marrow , physics , astrobiology
Background and purpose Fifteen percent of patients with myasthenia gravis (MG) are refractory to conventional treatment. Case reports and a few studies show probable benefit of rituximab in these cases. Our objective was to assess the efficacy and the safety of rituximab in patients with MG, in a multicentric real‐life study. Method Inclusion criteria were: age > 18 years; MG with anti‐acetylcholine receptor (AChR) antibodies, anti‐muscle‐specific kinase (MuSk) antibodies or significant decrement after repetitive nerve stimulation; Myasthenia Gravis Foundation of America (MGFA) class >II; refractory or steroid‐dependent MG; and treatment with rituximab. Efficacy was assessed at 6 months using the MGFA‐post‐intervention status (PIS) score, the myasthenic muscle score (MMS) and the number of patients receiving steroids <10 mg/day. Data on adverse events were collected. Results Twenty‐nine patients were included: 20 with anti‐AChR MG, five with anti‐MuSK MG and four with seronegative MG. MGFA‐PIS score was improved or better (improved, minimal manifestations or remission) in 86.2% of patients after 6 months of treatment ( P < 0.0001). The mean MMS increased from 68.8 to 83.1 ( P < 0.0001). A decrease in steroid dosage (<10 mg/day) was effective in 57.9% of treated patients. In all, 42.8% of patients experienced adverse events: infections (21.4% of patients); infusion reaction (7%); bradycardia (3.7%); and cytopenia (7%). Conclusion The present study demonstrates the efficacy and safety of rituximab in patients with MG. Additional studies remain necessary to determine the role of rituximab in the pharmacopeia of MG treatment and to establish precise recommendations for the infusion protocol.