Muto Kohei, Matsui Naoko, Unai Yuki, Sakai Waka, Haji Shotaro, Udaka Kengo, Miki Hirokazu, Furukawa Takahiro, Abe Masahiro, Kaji Ryuji
Department of Clinical Neuroscience, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
Department of Clinical Neuroscience, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
Neuromuscul Disord. 2017 Oct;27(10):918-922. doi: 10.1016/j.nmd.2017.06.012. Epub 2017 Jun 21.
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 IgDCD27 and IgDCD27 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.
利妥昔单抗（RTX）在重症肌无力（MG）中的免疫效应仍有待探索。我们旨在阐明MG患者的免疫反应及其与RTX治疗反应的关联。对MG患者的调节性T细胞和B细胞谱进行了监测。两名患有抗乙酰胆碱受体抗体的全身性MG患者接受了RTX治疗。治疗导致临床持续改善、静脉注射免疫球蛋白或血浆置换停用，以及泼尼松龙和其他药物用量减少。一名患者缓解超过一年，而另一名患者在一年内症状恶化。疾病活动与IgDCD27和IgDCD27记忆B细胞的重新增殖有关。临床医生应意识到MG患者B细胞耗竭持续时间存在差异的可能性，并且当记忆B细胞重新出现时应再次使用RTX。
