A retrospective study of the safety and efficacy of rituximab in Iranian patients with myasthenia gravis:  A single-center experience

Bentolhoda  Ziaadini; Narges  Karimi; Akram  Panahi; Ali Asghar  Okhovat; Farzad  Fatehi; Shahriar  Nafissi

doi:10.18502/cjn.v21i2.10492

Bentolhoda Ziaadini Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
Narges Karimi Immunogenetics Research Center, Mazandaran University of Medical Sciences, Sari, Iran
Akram Panahi Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
Ali Asghar Okhovat Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
Farzad Fatehi Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
Shahriar Nafissi Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran,

DOI: https://doi.org/10.18502/cjn.v21i2.10492

Keywords: Rituximab; Myasthenia Gravis; Activities of Daily Living; Outcome Measures; Acetylcholine Receptor; Autoantibodies; Muscle-Specific Tyrosine Kinase

Abstract

Background: This retrospective cohort study was conducted to evaluate the efficacy and tolerance of rituximab (RTX) for the management of myasthenia gravis (MG).

Methods: This retrospective cross-sectional study was conducted on 61 patients with refractory and
non-refractory MG who received RTX. The Myasthenia Gravis Activities of Daily Living (MG-ADL) profile was used to assess MG symptoms and their effects on daily activities at the start of RTX and in the last follow-up. The Myasthenia Gravis Foundation of America Post-Intervention Status (MGFA-PIS) scale has been used as an outcome measure after treatment with RTX in the 12^th month and the last follow-up.

Results: The mean age of the patients was 40.31 ± 13.53 years (range: 15-78 years). Of 61 patients, eight (13.1%) were double seronegative, 29 (47.5%) had anti-acetylcholine receptor (AChR+) antibody, and 24 (39.3%) had anti-muscle-specific tyrosine kinase antibody (MuSK+). According to the mean rank table, the results of this study showed that the drug was more effective in improving the symptoms of MuSK+ patients compared to the other two groups (P = 0.006). The mean MG-ADL was 4.86 ± 1.83 before treatment and 1.51 ± 2.02 in the last follow-up visit. Paired t-test showed a significant association between MG-ADL before and after treatment in the last visit [t(55): 11.30, 95% confidence interval (CI): 2.79-3.99, P = 0.001)].

Conclusion: This retrospective study showed a considerable effect of RTX as induction therapy in patients with MG, especially those with MuSk+ MG.