From the Research
The low-dose rituximab regimen for myasthenia gravis is more effective than the conventional dose, with 76.6% of patients achieving minimal manifestation status or better, and a more significant decrease in Quantitative MG Score (QMGs) from baseline, as shown in a recent meta-analysis 1.
Key Considerations
- The optimal dosing schedule for rituximab in myasthenia gravis remains undetermined, but low-dose regimens have shown promising results 1.
- Rituximab works by depleting CD20+ B cells, which are involved in antibody production contributing to the autoimmune process in myasthenia gravis.
- Patients should be monitored for potential side effects including infusion reactions, infections, and rare complications like progressive multifocal leukoencephalopathy.
- Complete blood counts and immunoglobulin levels should be checked periodically during treatment.
Treatment Approach
- The low-dose rituximab regimen may consist of a dose lower than the conventional 375 mg/m² administered intravenously once weekly for 4 consecutive weeks, although the exact dosing schedule is not specified in the available evidence.
- Prior to each infusion, patients should receive premedication with acetaminophen, diphenhydramine, and sometimes corticosteroids to prevent infusion reactions.
- Treatment response is usually monitored over 3-6 months, with many patients experiencing clinical improvement within this timeframe.
- Retreatment may be considered when symptoms recur, typically after 6-12 months, though some patients maintain remission for longer periods.
Patient Selection
- Rituximab is particularly useful for refractory cases or patients with antibody-positive disease.
- Mild disease severity, non-refractory MG, and low-dose rituximab are significant predictors for achieving an minimal manifestation status or better prognosis 1.
- Patients with MuSK-MG may also benefit from rituximab treatment, although the evidence is limited.