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Rituximab treatment of myasthenia gravis: A systematic review
Tandan R1, Hehir MK 2nd1, Waheed W1, Howard DB2.
Muscle Nerve. 2017 Feb 6. doi: 10.1002/mus.25597.
Rituximab is a chimeric mouse/human anti-CD20 monoclonal immunoglobulin.
We reviewed the efficacy and safety of rituximab in 169 myasthenia gravis (MG) patients from case reports and series.
Antibodies to the acetylcholine receptor (AChR) were present in 59% and muscle specific tyrosine kinase (MuSK) in 34%.
Modified Myasthenia Gravis Foundation of America post-intervention scale of minimal manifestations (MM) occurred in 44%, and combined pharmacological and chronic stable remission in 27% overall; MM or better was achieved in 72% of MuSK MG and 30% of AChR MG (P<0.001).
Post-treatment relapses decreased more in MuSK MG (P=0.05).
Response predictors were MuSK MG, less severe disease, and younger age at treatment. Among a responder subset, 26% of AChR and 82% of MuSK MG patients showed decreased post-treatment antibody titers.
Rituximab was generally well tolerated. Detectable serum rituximab and depleted CD20+ B-cells were observed up to 20 and 16 weeks, respectively, after 4 weekly infusions.