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dc.contributor.authorBlum, Stefanen_US
dc.contributor.authorGillis, Daviden_US
dc.contributor.authorBrown, Helenen_US
dc.contributor.authorBoyle, Richarden_US
dc.contributor.authorHenderson, Roberten_US
dc.contributor.authorHeyworth-Smith, Daviden_US
dc.contributor.authorHogan, Patricken_US
dc.contributor.authorKubler, Paulen_US
dc.contributor.authorLander, Cecilieen_US
dc.contributor.authorLimberg, Nicoleen_US
dc.contributor.authorPillans, Peteren_US
dc.contributor.authorPrain, Kerrien_US
dc.contributor.authorStaples, Christopheren_US
dc.contributor.authorWalsh, Michaelen_US
dc.contributor.authorMcCombe, Pamelaen_US
dc.contributor.authorWong, Richarden_US
dc.description.abstractBackground Myasthenia gravis is an autoimmune disorder of the neuromuscular junction. Rituximab (RTX), a monoclonal antibody to CD20, leads to B lymphocyte depletion and has been used in some autoimmune disorders, including small case series of myasthenia gravis patients. Methods A retrospective analysis was performed of all patients with acetylcholine receptor (AChR) (11 subjects) or muscle specific kinase antibody (MuSK) positive myasthenia gravis (three subjects), who had been treated with RTX in Brisbane, Australia. In most patients 1 g of RTX, in two divided doses, was given. Patients were monitored by serial clinical assessments, flow cytometry of peripheral blood B lymphocytes and antibody testing. Results RTX led to a significant improvement in symptoms in 11 of 14 patients. Doses of immunosuppressive medications were able to be reduced in 12 of 14 patients but medications could be completely ceased in only one patient. A demonstrable reduction of autoantibody levels was found in only three AChR positive patients and one MuSK positive patient, independent of clinical improvement. Peripheral blood B lymphocyte depletion was achieved in 13 out of 14 patients. B lymphocyte recovery occurred between 9 and 30 months post RTX (median 12.3 months) and was consistently associated with worsening of clinical symptoms. Conclusion Rituximab at a dose of 1 g appears to be beneficial in the treatment of patients with severe myasthenia gravis. Serial monitoring of peripheral blood B lymphocytes appears to be useful in guiding the need for further RTX therapy.en_US
dc.publisherBMJ Groupen_US
dc.publisher.placeUnited Kingdomen_US
dc.relation.ispartofjournalJournal of Neurology, Neurosurgery and Psychiatryen_US
dc.subject.fieldofresearchMedical and Health Sciences not elsewhere classifieden_US
dc.titleUse and monitoring of low dose rituximab in myasthenia gravisen_US
dc.typeJournal articleen_US
dc.type.descriptionC1 - Peer Reviewed (HERDC)en_US
dc.type.codeC - Journal Articlesen_US
gro.hasfulltextNo Full Text

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