RT Journal Article
T1 The impact of rituximab infusion protocol on the long-term outcome in anti-MuSK myasthenia gravis.
A1 Cortés-Vicente, Elena
A1 Rojas-Garcia, Ricard
A1 Díaz-Manera, Jordi
A1 Querol, Luis
A1 Casasnovas, Carlos
A1 Guerrero-Sola, Antonio
A1 Muñoz-Blanco, José Luis
A1 Bárcena-Llona, José Eulalio
A1 Márquez-Infante, Celedonio
A1 Pardo, Julio
A1 Martínez-Fernández, Eva María
A1 Usón, Mercedes
A1 Oliva-Nacarino, Pedro
A1 Sevilla, Teresa
A1 Illa, Isabel
AB To evaluate whether the clinical benefit and relapse rates in anti-muscle-specific kinase (MuSK) myasthenia gravis (MG) differ depending on the protocol of rituximab followed. This retrospective multicentre study in patients with MuSK MG compared three rituximab protocols in terms of clinical status, relapse, changes in treatment, and adverse side effects. The primary effectiveness endpoint was clinical relapse requiring a further infusion of rituximab. Survival curves were estimated using Kaplan-Meier methods and survival analyses were undertaken using Cox proportional-hazards models. Twenty-five patients were included: 11 treated with protocol 4 + 2 (375 mg/m2/4 weeks, then monthly for 2 months), five treated with protocol 1 + 1 (two 1 g doses 2 weeks apart), and nine treated with protocol 4 (375 mg/m2/4 weeks). Mean follow-up was 5.0 years (SD 3.3). Relapse occurred in 18.2%, 80%, and 33.3%, and mean time to relapse was 3.5 (SD 1.5), 1.1 (SD 0.4), and 2.5 (SD 1.4) years, respectively. Based on Kaplan-Meier estimates, patients treated with protocol 4 + 2 had fewer and later relapses than patients treated with the other two protocols (log-rank test P = 0.0001). Patients treated with protocol 1 + 1 had a higher risk of relapse than patients treated with protocol 4 + 2 (HR 112.8, 95% CI, 5.7-2250.4, P = 0.002). Patients treated with protocol 4 showed a trend to a higher risk of relapse than those treated with protocol 4 + 2 (HR 9.2, 95% CI 0.9-91.8, P = 0.059). This study provides class IV evidence that the 4 + 2 rituximab protocol has a lower clinical relapse rate and produces a more durable response than the 1 + 1 and 4 protocols in patients with MuSK MG.
SN 2328-9503
YR 2018
FD 2018-04-14
LK https://hdl.handle.net/10668/27413
UL https://hdl.handle.net/10668/27413
LA en
DS RISalud
RD Apr 12, 2025