抗MAG神经病变患者接受利妥昔单抗治疗后出现急性神经功能恶化。
Acute neurological worsening after Rituximab treatment in patients with anti-MAG neuropathy.
作者信息
Sala Emilie, Robert-Varvat Florence, Paul Stéphane, Camdessanché Jean-Philippe, Antoine Jean-Christophe
机构信息
Department of Neurology, University Hospital of Saint-Etienne, France; Reference Center for Rare Neuromuscular Diseases, University Hospital of Saint-Etienne, France.
Laboratory of Immunology, University Hospital of Saint-Etienne, France.
出版信息
J Neurol Sci. 2014 Oct 15;345(1-2):224-7. doi: 10.1016/j.jns.2014.07.055. Epub 2014 Aug 2.
BACKGROUND
Patients with peripheral neuropathy and anti-MAG monoclonal IgM may respond to Rituximab, a humanized monoclonal anti-CD20 antibody.
METHODS
We report on three patients with peripheral neuropathy and anti-MAG monoclonal IgM who deteriorated under Rituximab and reviewed seven previously published cases.
RESULTS
Worsening was acute and severe, and occurred during the treatment period. All the patients improved after deterioration but at final evaluation only one was improved comparatively to baseline, five were worsened and four were stabilized. Deterioration was not clearly associated with an increase of the anti-MAG antibody titer. Two patients received Rituximab prior or after the course which induced worsening without adverse reaction.
CONCLUSION
Although rare, acute worsening of the neuropathy can occur after Rituximab. The deterioration is however reversible within some weeks to several months.
背景
患有周围神经病且抗MAG单克隆IgM的患者可能对利妥昔单抗（一种人源化抗CD20单克隆抗体）有反应。
方法
我们报告了3例患有周围神经病且抗MAG单克隆IgM的患者，他们在接受利妥昔单抗治疗期间病情恶化，并回顾了7例先前发表的病例。
结果
病情恶化是急性且严重的，发生在治疗期间。所有患者在病情恶化后均有改善，但在最终评估时，只有1例相对于基线有所改善，5例病情恶化，4例病情稳定。病情恶化与抗MAG抗体滴度升高没有明显关联。2例患者在导致病情恶化的疗程之前或之后接受利妥昔单抗治疗，未出现不良反应。
结论
尽管罕见，但利妥昔单抗治疗后周围神经病可能会急性恶化。然而，病情恶化在数周至数月内是可逆的。
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