Neuromuscular Medicine, Department of Neurology, Johns Hopkins University School of Medicine, Meyer 5-119A, 600N. Wolfe Street, Baltimore, MD 21287, United States.
Neuromuscular Medicine, Department of Neurology, Johns Hopkins University School of Medicine, Meyer 5-119A, 600N. Wolfe Street, Baltimore, MD 21287, United States.
Neuromuscul Disord. 2019 Jul;29(7):554-561. doi: 10.1016/j.nmd.2019.06.002. Epub 2019 Jun 6.
Rituximab is a chimeric monoclonal antibody that binds CD20 and causes the depletion of B-cell subsets. Although initially designed to treat lymphoma, it has found wide use in the management of various autoimmune conditions, including myasthenia gravis (MG), an autoimmune disorder of the neuromuscular junction. Treated myasthenia patients are often on an oral steroid-sparing agent. To determine the safety of stopping oral steroid-sparing agents at the initiation of rituximab therapy and its effectiveness we reviewed the records of 27 MG patients with rituximab, including 13 with anti-MuSK+ MG, 10 with anti-AChR+ MG, and 4 double seronegative MG patients. All patients that were on an oral steroid-sparing agent (21 of 27) were able to stop it, and they did not require re-introduction of the medication. Also, the daily prednisone dosage was significantly decreased in 20/24 patients across all three serotype groups. MGFA post intervention status analysis also showed 15/27 of all patients achieved minimal manifestation status or remission across all groups. Antibody titers decreased dramatically and promptly in anti-MuSK+ MG patients. Our data suggests that stopping oral steroid-sparing agents at initiation of rituximab therapy is safe. Also, our data indicates that rituximab is highly effective in the management of seropositive MG patients.
利妥昔单抗是一种嵌合型单克隆抗体，能与 CD20 结合并导致 B 细胞亚群耗竭。尽管最初设计用于治疗淋巴瘤，但它已广泛用于治疗各种自身免疫性疾病，包括重症肌无力（MG），这是一种神经肌肉接头的自身免疫性疾病。接受治疗的 MG 患者通常使用口服类固醇维持药物。为了确定在开始利妥昔单抗治疗时停用口服类固醇维持药物的安全性及其疗效，我们回顾了 27 例接受利妥昔单抗治疗的 MG 患者的记录，其中包括 13 例抗 MuSK+MG 患者、10 例抗 AChR+MG 患者和 4 例双阴性 MG 患者。所有正在使用口服类固醇维持药物的患者（27 例中的 21 例）都能够停用该药物，且无需重新使用该药物。此外，在所有三组血清型患者中，20/24 例患者的每日泼尼松剂量显著减少。MGFA 干预后状态分析也显示，所有患者中有 15/27 例在所有组中均达到最小症状状态或缓解。抗 MuSK+MG 患者的抗体滴度显著且迅速下降。我们的数据表明，在开始利妥昔单抗治疗时停用口服类固醇维持药物是安全的。此外，我们的数据表明，利妥昔单抗在治疗血清阳性 MG 患者方面非常有效。
