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Letter
Long-term follow-up of patients with myasthenia gravis treated with low-dose rituximab
  1. Fiona Chan1,
  2. Andrew Swayne1,2,
  3. David Gillis3,4,
  4. Michael Walsh1,
  5. Robert D Henderson5,6,
  6. Pamela A McCombe5,6,
  7. Richard C Wong1,4,
  8. Stefan Blum1,2
  1. 1 Department of Neurology, Princess Alexandra Hospital, Wooloongabba, Queensland, Australia
  2. 2 Mater Hospital Brisbane, Mater Centre for Neuroscience, South Brisbane, Queensland, Australia
  3. 3 Department of Immunology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
  4. 4 Health Support Queensland Pathology Queensland, Pathology Queensland, Herston, Queensland, Australia
  5. 5 Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  6. 6 School of Medicine, University of Queensland, St Lucia, Queensland, Australia
  1. Correspondence to Dr Stefan Blum, Department of Neurology, Princess Alexandra Hospital, Wooloongabba, QLD 4102, Australia; stefan.blum{at}health.qld.gov.au

https://doi.org/10.1136/jnnp-2018-319410

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    Introduction

    Myasthenia gravis (MG) is a disease of the neuromuscular junction, usually caused by an autoimmune process associated with antibodies against the acetylcholine receptor (AChR) or muscle-specific kinase (MuSK). Rituximab (RTX), a monoclonal antibody targeting CD20, has emerged as a potential treatment in the management of MG, in particular for MuSK positive patients.1 2 Most (80%) patients received 375 mg/m2 of RTX per week for 4 weeks, with lower doses being infrequently reported.

    We previously reported on our experience with low-dose RTX in the treatment of MG3 and now report our long-term experience from an enlarged cohort.

    Methods

    We identified retrospectively all patients with MG treated with RTX between May 2006 and July 2017 in South East Queensland, Australia. Cases were identified via review of pharmacy and hospital records as well as by direct contact with the treating neurologists.

    The clinical states of patients were scored using the Myasthenia Gravis Association of America (MGFA) Clinical Research Standards. Disease severity and concurrent therapies were documented through review of medical records (Timepoints: Diagnosis, RTX treatment, 3-monthly for the first year, annually thereafter). Wilcoxon ranked test was used to assess difference in steroid doses.

    Results

    Patient characteristics

    A total of 38 patients were treated (AChR: 28 patients (74%, female:male (F:M)=18:10), MuSK: six patients (16%, F:M=4:2), antibody negative four patients (10%, all female)). The mean age at initial treatment was 51.5 (range 22–87 years) with mean disease duration prior to …

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    Footnotes

    • Contributors FC and AS performed data collection and wrote the initial drafts of the manuscript. DG, MW, RDH, PAM and RCW were involved in patient care and revision of manuscript. SB was involved in patient care and writing of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Human Research Ethics Committee, Metro South Health, Queensland Australia.

    • Provenance and peer review Not commissioned; externally peer reviewed.