Efficacy and Safety of Rituximab for Myasthenia Gravis: a Systematic Review and Meta-analysis

Overview

Journal J Neurol

Specialty Neurology

Date 2014 Oct 14

PMID 25308632

Citations 64

Authors

Raffaele Iorio

Valentina Damato

Paolo Emilio Alboini

Amelia Evoli

Affiliations

Soon will be listed here.

Abstract

Myasthenia gravis is an autoimmune disorder of the neuromuscular junction caused by circulating antibodies specific for the post-synaptic acetylcholine receptor or, in a minority of cases, for the muscle-specific tyrosine-kinase and the low-density lipoprotein receptor-related protein 4. A wide range of symptomatic and immunosuppressive treatments is currently available for MG patients with variable outcome. However, most immunosuppressive treatments are characterized by delayed onset of action and in some cases are not sufficient to induce stable remission of the disease. Rituximab (RTX) is a chimaeric monoclonal antibody specific for the CD20 B-cell surface antigen. Recent studies have provided evidence that RTX may be an effective treatment for patients with myasthenia gravis (MG) who are refractory to standardized immunosuppressive therapy. We performed a systematic review and a meta-analysis of the efficacy and safety of RTX in myasthenia gravis considering the potential predictive factors related to patients' response to RTX in this disease.

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References

Stieglbauer K, Topakian R, Schaffer V, Aichner F . Rituximab for myasthenia gravis: three case reports and review of the literature. J Neurol Sci. 2009; 280(1-2):120-2. DOI: 10.1016/j.jns.2009.02.357. View

Kuntzer T, Carota A, Novy J, Cavassini M, Du Pasquier R . Rituximab is successful in an HIV-positive patient with MuSK myasthenia gravis. Neurology. 2011; 76(8):757-8. DOI: 10.1212/WNL.0b013e31820d6290. View

Sun F, Ladha S, Yang L, Liu Q, Shi S, Su N . Interleukin-10 producing-B cells and their association with responsiveness to rituximab in myasthenia gravis. Muscle Nerve. 2013; 49(4):487-94. DOI: 10.1002/mus.23951. View

Yi J, Decroos E, Sanders D, Weinhold K, Guptill J . Prolonged B-cell depletion in MuSK myasthenia gravis following rituximab treatment. Muscle Nerve. 2013; 48(6):992-3. PMC: 4230922. DOI: 10.1002/mus.24063. View

Lau A, Chan A, Mok V . Refractory bulbar and respiratory dysfunction in a young Chinese woman with seronegative, muscle-specific tyrosine kinase antibody-positive myasthenia gravis: response to cyclophosphamide and rituximab treatment. Hong Kong Med J. 2011; 17(1):77-9. View

Kerkeni S, Marotte H, Miossec P . Improvement with rituximab in a patient with both rheumatoid arthritis and myasthenia gravis. Muscle Nerve. 2008; 38(4):1343-5. DOI: 10.1002/mus.21047. View

Gurcan H, Keskin D, Stern J, Nitzberg M, Shekhani H, Ahmed A . A review of the current use of rituximab in autoimmune diseases. Int Immunopharmacol. 2008; 9(1):10-25. DOI: 10.1016/j.intimp.2008.10.004. View

Lin P, Martin B, Weinacker A, So Y . High-dose cyclophosphamide in refractory myasthenia gravis with MuSK antibodies. Muscle Nerve. 2005; 33(3):433-5. DOI: 10.1002/mus.20411. View

Hultin L, Hausner M, Hultin P, Giorgi J . CD20 (pan-B cell) antigen is expressed at a low level on a subpopulation of human T lymphocytes. Cytometry. 1993; 14(2):196-204. DOI: 10.1002/cyto.990140212. View

10.

Leandro M, Cambridge G, Ehrenstein M, Edwards J . Reconstitution of peripheral blood B cells after depletion with rituximab in patients with rheumatoid arthritis. Arthritis Rheum. 2006; 54(2):613-20. DOI: 10.1002/art.21617. View

11.

Jaretzki 3rd A, Barohn R, Ernstoff R, Kaminski H, KEESEY J, Penn A . Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Neurology. 2000; 55(1):16-23. DOI: 10.1212/wnl.55.1.16. View

12.

Meriggioli M, Sanders D . Muscle autoantibodies in myasthenia gravis: beyond diagnosis?. Expert Rev Clin Immunol. 2012; 8(5):427-38. PMC: 3505488. DOI: 10.1586/eci.12.34. View

13.

Skeie G, Apostolski S, Evoli A, Gilhus N, Illa I, Harms L . Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol. 2010; 17(7):893-902. DOI: 10.1111/j.1468-1331.2010.03019.x. View

14.

Baek W, Bashey A, Sheean G . Complete remission induced by rituximab in refractory, seronegative, muscle-specific, kinase-positive myasthenia gravis. J Neurol Neurosurg Psychiatry. 2007; 78(7):771. PMC: 2117664. DOI: 10.1136/jnnp.2006.093567. View

15.

Thakre M, Inshasi J, Marashi M . Rituximab in refractory MuSK antibody myasthenia gravis. J Neurol. 2007; 254(7):968-9. DOI: 10.1007/s00415-006-0442-2. View

16.

Wylam M, Anderson P, Kuntz N, Rodriguez V . Successful treatment of refractory myasthenia gravis using rituximab: a pediatric case report. J Pediatr. 2003; 143(5):674-7. DOI: 10.1067/S0022-3476(03)00300-7. View

17.

Mahevas M, Michel M, Weill J, Reynaud C . Long-lived plasma cells in autoimmunity: lessons from B-cell depleting therapy. Front Immunol. 2014; 4:494. PMC: 3873528. DOI: 10.3389/fimmu.2013.00494. View

18.

Hauser S, Waubant E, Arnold D, Vollmer T, Antel J, Fox R . B-cell depletion with rituximab in relapsing-remitting multiple sclerosis. N Engl J Med. 2008; 358(7):676-88. DOI: 10.1056/NEJMoa0706383. View

19.

Drachman D, Adams R, Hu R, Jones R, Brodsky R . Rebooting the immune system with high-dose cyclophosphamide for treatment of refractory myasthenia gravis. Ann N Y Acad Sci. 2008; 1132:305-14. PMC: 3390145. DOI: 10.1196/annals.1405.033. View

20.

Reff M, Carner K, Chambers K, Chinn P, Leonard J, Raab R . Depletion of B cells in vivo by a chimeric mouse human monoclonal antibody to CD20. Blood. 1994; 83(2):435-45. View