Rituximab as Adjunct Maintenance Therapy for Refractory Juvenile Myasthenia Gravis

Carla D. Zingariello, Melissa E. Elder, Peter B. Kang

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Juvenile myasthenia gravis is a pediatric autoimmune disorder of the neuromuscular junction associated with significant morbidity, for which standard therapies are not always efficacious. The objective of our study was to assess the tolerability and efficacy of rituximab use in children with refractory juvenile myasthenia gravis. Methods: We conduced a retrospective cohort study at a single tertiary care referral center to evaluate children with juvenile myasthenia gravis who were treated with rituximab. The clinical status of these participants before and after initiation of rituximab therapy was measured, focusing on numbers of hospital admissions, numbers of immunomodulatory or immunosuppressive medications needed, and Myasthenia Gravis Foundation of America severity class. Results: Five children with juvenile myasthenia gravis were ascertained who received rituximab as part of their regimen, four of whom had elevated acetylcholine receptor antibodies and one of whom had elevated muscle-specific kinase antibodies. After initiation of rituximab therapy, all participants experienced reduced numbers of immunomodulatory medications during the follow-up period (mean 11.6 months). Four of the five subjects experienced fewer juvenile myasthenia gravis-related hospital admissions and reduced (improved) Myasthenia Gravis Foundation of America classes, with no subjects having moderate or severe symptoms following treatment with rituximab. No significant adverse events were recorded for any of the participants. Conclusion: Rituximab was well-tolerated and efficacious in this juvenile myasthenia gravis cohort. The beneficial effect of rituximab was most pronounced in the one participant with muscle-specific kinase antibodies.

Original languageEnglish (US)
Pages (from-to)40-43
Number of pages4
JournalPediatric Neurology
Volume111
DOIs
StatePublished - Oct 2020
Externally publishedYes

Bibliographical note

Funding Information:
Funding: This study was funded in part by a grant from the Children's Miracle Network.

Funding Information:
Funding: This study was funded in part by a grant from the Children’s Miracle Network .

Publisher Copyright:
© 2020 Elsevier Inc.

Keywords

  • Acetylcholine receptor antibodies
  • Juvenile myasthenia gravis
  • MuSK antibodies
  • Rituximab

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't

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