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Rituximab in myasthenia gravis: efficacy, associated infections and risk of induced hypogammaglobulinemia

2022; Elsevier BV; Volume: 32; Issue: 8 Linguagem: Inglês

10.1016/j.nmd.2022.06.006

1873-2364

Marta Caballero‐Ávila, Rodrigo Álvarez‐Velasco, Esther Moga, Ricard Rojas‐García, Janina Turón‐Sans, Luís Querol, Montse Olivé, David Reyes‐Leiva, Isabel Illa, Eduard Gallardo, Elena Cortés‐Vicente,

Salivary Gland Tumors Diagnosis and Treatment

The aim of this study is to evaluate the long-term efficacy, safety, and impact on immunoglobulin G (IgG) levels of rituximab in patients with myasthenia gravis (MG). A retrospective, observational study of drug-refractory MG patients treated with rituximab was done. The MG Foundation of America postintervention status (MGFA-PIS) was used to evaluate clinical response. Serum IgG levels were determined at baseline and post-treatment. Hypogammaglobulinemia was defined as IgG<7g/L. Thirty patients were included, 12 with anti-MuSK and 18 with anti-AChR antibodies. Mean (SD) follow-up was 85.5 (48) months. All 12 MuSK+ patients but only six (33%) AChR+ patients achieved minimal manifestations or remission (p<0.01). Nine severe infections were observed in five patients (17%). One patient was diagnosed with progressive multifocal leukoencephalopathy. At baseline, two patients (2/24; 8%) had hypogammaglobulinemia. During follow-up, hypogammaglobulinemia was observed in 60% (3/5) of patients who developed an infection and in 33% (7/21) who did not. Two of these patients died of infection-related complications. This study supports the effectiveness of rituximab in patients with MG, especially those with anti-MuSK antibodies. Severe infections may appear after rituximab treatment and hypogammaglobulinemia might play a role on it. A standard protocol would be needed to closely monitor IgG levels in MG patients treated with rituximab.