Long-Term Efficacy and Safety of Low-Dose Rituximab in Patients with Refractory Myasthenia Gravis.

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

European Neurology Pub Date : 2023-01-01 Epub Date: 2023-09-30 DOI:10.1159/000534336

Jingru Ren, Jianchun Wang, Ran Liu, Yunyi Jin, Jing Guo, Yan Yao, Jingjing Luo, Hongjun Hao, Feng Gao

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Abstract

Introduction: Rituximab is a monoclonal chimeric antibody against CD20+ B cells. We aimed to assess the long-term efficacy and safety of CD20+ B cell-guided treatment with low-dose rituximab in refractory myasthenia gravis patients.

Methods: Patients with refractory myasthenia gravis treated with rituximab for more than 2 years were included. Rituximab was administered when CD20+ B cells were greater than 1%. We analysed the efficacy of rituximab, treatment interval, side effects, prognosis, and treatment course.

Results: A total of 22 patients were included. All patients received 2-12 doses of rituximab, and the median follow-up time was 48.5 months. The scores of the Myasthenia Gravis Activities of Daily Living and Myasthenia Gravis Composite were significantly lower than those at baseline (p < 0.05). MGFA-PIS was significantly improved in 21 (95.45%) patients and 14 (63.64%) patients have reached MGFA-PIS minimal manifestations. The average daily dose of prednisone and pyridostigmine bromide and the proportion of immunosuppressants were significantly lower (p < 0.05). Seven patients suffered from 14 worsenings. Eight patients terminated rituximab due to good efficacy. Most patients tolerated rituximab well, although 1 patient had opportunistic infection and hypogammaglobulinemia, 1 patient had an intracranial mass.

Conclusion: Long-term CD20+ B-cell-guided low-dose rituximab showed good efficacy and tolerance in patients with refractory myasthenia gravis.

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低剂量利妥昔单抗治疗难治性重症肌无力的长期疗效和安全性。

简介利妥昔单抗是一种抗CD20+B细胞的单克隆嵌合抗体。我们旨在评估低剂量利妥昔单抗治疗难治性重症肌无力患者的长期疗效和安全性。方法纳入利妥昔单抗治疗2年以上顽固性重症肌无力患者。当CD20+B细胞大于1%时给予利妥昔单抗。我们分析了利妥昔单抗的疗效、治疗间隔、副作用、预后和疗程。结果共纳入22例患者。所有患者均接受了2-12剂利妥昔单抗，中位随访时间为48.5个月。重症肌无力日常生活活动能力和重症肌无力综合征评分均显著低于基线（P<0.05），MGFA-PIS有21例（95.45%）患者明显改善，14例（63.64%）患者达到MGFA-PIS最低表现。泼尼松和溴化吡啶斯的明的平均日剂量和免疫抑制剂的比例显著降低（P＜0.05）。8名患者因疗效良好而终止使用利妥昔单抗。大多数患者对利妥昔单抗耐受良好，但有一名患者出现机会性感染和低丙种球蛋白血症。结论长期应用CD20+B细胞介导的低剂量利妥昔单抗治疗难治性重症肌无力具有良好的疗效和耐受性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Neurology 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

审稿时长

4-8 weeks

期刊介绍： ''European Neurology'' publishes original papers, reviews and letters to the editor. Papers presented in this journal cover clinical aspects of diseases of the nervous system and muscles, as well as their neuropathological, biochemical, and electrophysiological basis. New diagnostic probes, pharmacological and surgical treatments are evaluated from clinical evidence and basic investigative studies. The journal also features original works and reviews on the history of neurology.