Treating MG with rituximab alone is as effective as…

Taking Rituximab alone is as effective as combining it with corticosteroids for the treatment of myasthenia gravis (MG) and has the advantage of reducing the number of patients who need rescue treatment and use immunosuppressants, a French study gets it.

According to the researchers, “this shows that avoiding steroids can reduce long-term side effects and reduce salvage treatments without affecting the outcome of MG.” The study, “Rituximab alone is as effective as in combination with steroids in naive patients with generalized myasthenia gravis.,” was published in Journal of Neurology.

MG is an autoimmune disease characterized by a breakdown of nerve-muscle communication. It is driven by autoantibodies that target proteins that play an important role in the process, usually acetylcholine receptors (AChRs) and muscle-specific kinase (MuSK). B-cells, a type of immune cell specialized for producing antibodies, are the main source of antibodies in MG.

Rituximab, commercially available as Rituxan and others, is an antibody-based treatment that targets and destroys B-cells. It is not specifically approved for MG, but evidence supports its effectiveness in managing the disease in patients who do not respond to other common immunosuppressants, including those with anti-MuSK antibodies.

Corticosteroids, which work broadly by suppressing immune system activity and reducing inflammation, remain the treatment of choice for early stabilization of MG due to their widespread availability, low cost , and real action. Their side effects may limit their long-term use, however.

“Leaving [MG] is a chronic condition, long-term treatments need to have as few side effects as possible,” the researchers wrote.

To assess the effectiveness of rituximab as a stand-alone treatment for MG, French researchers analyzed data from 68 patients who received it as first-line treatment, either alone (49 patients; 72.1%) or corticosteroids (19 patients; 27.9%) .

High-dose rituximab alone

Treatment regimen consisted of two 1 g intravenous infusions on two occasions 15 days apart. Other treatment cycles were based on B-cell counts and patients were evaluated every three months after their transplant.

68 patients were 59.9 years old when they received their first infusion. More than half had severe MG (53.7%) and most were positive for autoantibodies to AChR (82.4%).

At the time of inclusion, patients in the combined treatment group had more severe MG than those in the rituximab-only group, as determined by their Osserman score (64.9 vs. 74.1).

Equivalent treatment efficacy was observed in both groups after implantation, with MG weight and Osserman scores different between the two groups at three, six, nine and 12 months after ‘a first installation.

Fewer patients in the rituximab alone group required salvage therapy than in the combination group (20.4% vs. 47.4%). Also, fewer rituximab-only patients needed immunosuppressants than those who took rituximab with corticosteroids (2.04% vs. 21.05%).

“High rate of immunosuppressive therapy after treatment with [rituximab] and a high rate of rescue treatment suggests a high success rate [rituximab] one to MG stability. However, it can also be explained by the seriousness of patients under corticosteroids with the addition of an immunosuppressant. Further studies need to be considered to test that hypothesis,” the researchers wrote.

There was no difference between the two groups in terms of safety outcomes.

“Our work suggests that [rituximab] one acts as an organization of [rituximab] and corticosteroids in MG patients,” wrote the researchers, who added that using it with newer MG treatments “will require discussion.”