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The use of rituximab in myasthenia gravis and Lambert–Eaton myasthenic syndrome
  1. Paul Maddison1,
  2. John McConville2,
  3. Maria Elena Farrugia3,
  4. Nicholas Davies4,
  5. Michael Rose5,
  6. Fiona Norwood5,
  7. Heinz Jungbluth6,
  8. Stephanie Robb7,
  9. David Hilton-Jones8
  1. 1Department of Neurology, Queen's Medical Centre, Nottingham, UK
  2. 2Department of Neurology, Ulster Hospital, Dundonald, Belfast, UK
  3. 3Neurology Department, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
  4. 4Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Birmingham, UK
  5. 5Department of Neurology, King's College Hospital, Denmark Hill, London, UK
  6. 6Department of Paediatric Neurology—Neuromuscular Service, Evelina Children's Hospital, St Thomas' Hospital, London, UK
  7. 7Dubowitz Neuromuscular Centre, Great Ormond Street Hospital for Children, London, UK
  8. 8Department of Clinical Neurology, West Wing, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Dr Paul Maddison, Department of Neurology, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK; paul.maddison{at}nhs.net

Abstract

Aim To assess the treatment effects of rituximab in a population of patients with myasthenia gravis and Lambert–Eaton myasthenic syndrome.

Methods Data on all treated patients in the UK were collected from referring physicians, with full case ascertainment and follow-up.

Results Since 2004, 10 patients with generalised myasthenia gravis (three of whom were positive for muscle-specific tyrosine kinase (MuSK) antibodies) and two patients with Lambert–Eaton myasthenic syndrome (LEMS) were treated with rituximab. Using the Myasthenia Gravis Foundation America postintervention status, three patients (25%) achieved remission, and a further five (42%) improved clinically over an 18-month period. Only one patient developed worsening symptoms. The probability of achieving remission was unrelated to the duration of neurological symptoms prior to treatment. All LEMS and MuSK antibody patients improved following rituximab treatment.

Conclusion In a relatively large, unselected group of patients with myasthenia gravis and LEMS, rituximab treatment resulted in a significant clinical improvement in two-thirds of cases. As a selective, B cell targeted therapy, rituximab should be considered as a treatment option for patients with either myasthenia gravis or LEMS for whom standard immunosuppressive treatments have been unsuccessful.

  • Myasthenia gravis
  • Lambert–Eaton myasthenic syndrome
  • rituximab
  • myasthenia

https://doi.org/10.1136/jnnp.2009.197632

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    Footnotes

    • Competing interests None.

    • Ethics approval Ethics approval was provided by the North Nottinghamshire Research Ethics Committee 09/H0407/39.

    • Provenance and peer review Not commissioned; externally peer reviewed.