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  • Durability of the Rituximab Response in Myasthenia Gravis

    By Marianne Doran and selected by Deepak P. Edward, MD
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    Journal Highlights

    JAMA Neurology
    2017;74(1):60-66

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    Although the benefits of B-cell–targeted therapy with rituximab have been ob­served in myasthenia gravis (MG), the duration of these effects after treatment is unclear. Thus, Robeson et al. set out to evaluate the durability of response to rituximab in the treatment of refractory acetylcholine receptor autoantibody–positive (AChR+) generalized MG. They found that 56% of patients who had achieved disease control relapsed at a mean of 36 months of follow-up, while 44% remained relapse free at a mean follow-up of 47 months after the last rituximab treatment.

    This retrospective case series includ­ed 16 patients with AChR+ MG who were treated at an MG clinic from Jan. 1, 2007, to Dec. 31, 2015. The patients received rituximab and were followed for 18 to 84 months after treatment. The main outcome measures included long-term clinical response, durability of response and/or relapse rate, AChR autoantibody levels, adverse effects, and inflammatory markers.

    All patients achieved complete stable remission, pharmacologic remission, or minimal manifestations, as defined by Myasthenia Gravis Foundation of America criteria. The improvement was observed in parallel with complete withdrawal or reduction of other im­munotherapies. With regard to AChR antibodies, a 33% decrease was seen after cycle 1 of rituximab, 20% after cy­cle 2 (compared with cycle 1), and 17% after cycle 3 (compared with cycle 2).

    Nine patients (56%) experienced a relapse during a mean follow-up of 36 months (range, 24-47 months). Seven patients (44%) remained relapse free at a mean follow-up of 47 months (range, 18-81 months) since their last rituximab treatment.

    The authors concluded that ritux­imab therapy appears to be an effec­tive option in patients with refractory AChR+ MG, who were observed to have had a durable response after treatment. Identification of markers of disease relapse and sustained remission are critical next steps in the development of pathophysiology-relevant, evidence-based practice parameters for ritux­imab in the treatment of MG.

    The original article can be found here.