Efficacy of rituximab in refractory or corticosteroid-dependent myasthenia gravis, a real-life study

Myasthenia gravis is characterized by dysfunction of the neuromuscular junction. Its manifestations are refractory to the usual treatments (anticholinesterase drugs, corticosteroids, etc.) in 15% of cases. Rituximab, an anti-CD20 monoclonal antibody, therefore constitutes a second-line therapeutic alternative. Several case publications or case series support this option.

In an article published in June 2020, a French team reports the results of a real-life multicenter study conducted in 29 patients aged 18 and over, with myasthenia gravis refractory or dependent on corticosteroids and treated with rituximab. Twenty of them had anti-RACh autoantibodies, five had anti-MuSKs, and four were HIV negative. The results of this study confirm the efficacy of rituximab at 6 months, with:

  • a favorable evolution (improvement, minimal manifestations or remission) of the post-interventional Myasthenia Gravis Foundation of America (MGFA) status in 86.2% of the participants;
  • an increase in the myasthenic muscle score (MMS) from an average of 68 to 83.1;
  • a reduction in the dose of corticosteroids below 10 mg / day in 57.9% of patients.

Less than half (42.8%) of participants experienced adverse effects: infections (21.4% of patients), infusion reaction (7%), cytopenia (7%), bradycardia (3.7%).


Efficacy and safety of Rituximab in myasthenia gravis: A French multicentre real-life study. Dos Santos A, Noury JB, Genestet S; et al. Eur J Neurol. 2020 Jun 11.