Dario Ricciardi
Rituximab in refractory myasthenia gravis: 5 year single center follow up
Autori
- DARIO RICCIARDI (UOC NEUROFISIOPATOLOGIA AORN CARDARELLI – NEUROLOGIA)
- CARMEN ERRA (UOC NEUROFISIOPATOLOGIA AORN CARDARELLI – NEUROLOGIA)
- FRANCESCO TUCCILLO (UOC NEUROFISIOPATOLOGIA AORN CARDARELLI – NEUROLOGIA)
- FASOLINO ALESSANDRA (UOC NEUROFISIOPATOLOGIA AORN CARDARELLI – NEUROLOGIA)
- BERNARDO MARIA DE MARTINO (AORN SANTOBONO – NEUROLOGIA)
- FRANCESCO HABETSWALLNER (UOC NEUROFISIOPATOLOGIA AORN CARDARELLI – NEUROLOGIA)
Presentatore
DARIO RICCIARDI
Modalità
Oral Communication
Abstract
Myasthenia gravis (MG) is a B cell mediated disease. Rituximab, an anti-CD20 monoclonal antibody, is the main B cell-depleting therapy used to this day in MG. CD20 is expressed throughout B cell maturation from the pre-B cell stage through the other maturation stages including short-lived plasma cells (plasmablasts), the main cells responsible for anti-Musk IgG4 production. However, rituximab does not affect long-lived CD20-negative plasma cells, which are responsible for producing IgG1/IgG3 anti-AChR antibodies. For this reason, the response to RTX in AChR-MG appears to be significantly more delayed and weaker.
This study aims to describe our single-center experience in the use of Rituximab in anti-AchR and anti-Musk MG with standard dose and low dose regimens.
A retrospective evaluation of MG patients treated with rituximab at our MG center was conducted. Clinical outcome through standardized clinical scales (MGADL, MGFA, MGFA-PIS) was recorded after 6 months, 1 year, and 2 and 5. Steroid spearing effect was also recorded as the number of patients who had suspended steroid therapy.
39 patients were analysed (23 Anti-Achr MG patients, 15 anti-Musk MG patients and 1 sieronegative). Both groups showed a significant clinical improvement and steroid sparing effect, both more significant and prolonged in the anti-Musk MG group with a high rate of clinical remission. Five patients (anti-AhcR MG) were considered nonresponders. One of these patients showed an elevated anti-rituximab antibody titre.
Rituximab is a valid therapeutic tool in MG, especially in anti-Musk patients, with an high rate of clinical remission.