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Memory B cell resurgence requires repeated rituximab in myasthenia gravis

2017; Elsevier BV; Volume: 27; Issue: 10 Linguagem: Inglês

10.1016/j.nmd.2017.06.012

1873-2364

Kohei Muto, Naoko Matsui, Yuki Unai, Waka Sakai, Shotaro Haji, Kengo Udaka, Hirokazu Miki, Takahiro Furukawa, Masahiro Abe, Ryuji Kaji,

Peripheral Neuropathies and Disorders

The immunologic effects of rituximab (RTX) in myasthenia gravis (MG) remain to be explored. We aimed to clarify immunologic reactions and their association with response to RTX in MG. Regulatory T cell and B cell profiles of MG patients were monitored. Two patients presenting with generalized MG with anti-acetylcholine receptor antibodies were treated with RTX. The treatment led to sustained clinical improvement, discontinuation of intravenous immunoglobulin or plasma exchange, and reduction of prednisolone and other drugs. One patient was in remission for more than one year, whereas the other patient exhibited deterioration of symptoms within one year. Disease activity was associated with the repopulation of IgD−CD27− and IgD−CD27+ memory B cells. Clinicians should be aware of the possibility that MG ranges in the duration of B cell depletion and additional RTX should be prescribed upon resurgence of memory B cells.