Rituximab for the Treatment of Myasthenia Gravis: A 2021 Update

Abstract


 Low-quality evidence suggests that treatment with rituximab may be associated with improvements in clinical status, use of concurrent immunomodulatory therapies, quality of life, and various laboratory parameters in patients with myasthenia gravis, compared to before treatment. However, substantial methodological limitations of the included literature limit the use of these findings for informing clinical and policy decisions.
 Adverse events associated with the use of rituximab were relatively common, occurring in approximately 25% to 45% of patients treated with rituximab. The adverse events experienced by patients were not considered serious by primary study authors.
 No studies were identified that compared the effectiveness of rituximab to other therapies for the treatment of myasthenia gravis. Summarized studies lacked control groups, meaning that any outcomes observed in study participants should not be attributed to rituximab alone.
 There is a lack of evidence on the cost-effectiveness of rituximab for the treatment of myasthenia gravis. Additionally, no evidence-based guidelines were identified.

Autoreactive B cells in rheumatoid arthritis include mainly activated CXCR3+ memory B cells and plasmablasts

“…Many autoimmune diseases (AIDs), such as rheumatoid arthritis (RA), pemphigus vulgaris, systemic lupus erythematosus, or myasthenia gravis, are characterized by the presence of disease-specific autoantibodies. Together with the notable efficacy of B cell depletion therapy, this indicates a central role for autoreactive B cells in disease pathogenesis (1)(2)(3)(4). Often, autoantibody responses have been well characterized.…”

Myasthenia Gravis and Lambert-Eaton Myasthenic Syndrome: New Developments in Diagnosis and Treatment

“…Rituximab was well-tolerated and there were no safety issues observed in this study. 66 A comprehensive 2021 review from the Canadian Agency for Drugs and Technologies in Health of published experience with rituximab in generalized MG (one systematic review with meta-analysis and nine non-randomized studies) reached the following conclusions: 30 while rituximab appeared to be associated with improvement in patients with myasthenia gravis, definitive conclusions were not possible and that the findings needed to be interpreted with caution. 30 Neonatal Fc Receptor-Targeted Therapy for MG Of the many new strategies being developed as novel treatment for MG there is major focus on the neonatal Fc receptor (FcRn).…”

“…A comprehensive 2021 review from the Canadian Agency for Drugs and Technologies in Health of published experience with rituximab in generalized MG (one systematic review with meta-analysis and nine non-randomized studies) reached the following conclusions: 30 while rituximab appeared to be associated with improvement in patients with myasthenia gravis, definitive conclusions were not possible and that the findings needed to be interpreted with caution. 30 …”

“…while rituximab appeared to be associated with improvement in patients with myasthenia gravis, definitive conclusions were not possible and that the findings needed to be interpreted with caution. 30 …”

Comparing Safety and Efficacy of Rituximab and Eculizumab in Treating Refractory Myasthenia Gravis: A Systematic Review

“…Myasthenia gravis is a chronic autoimmune disorder of the neuromuscular junction that weakens and exhausts skeletal muscle by targeting different parts of the postsynaptic membrane with immune system-produced antibodies (1). Most patients with myasthenia gravis develop auto-antibodies against postsynaptic acetylcholine receptors at the neuromuscular junction end plates.…”