The aim of this study is to evaluate the long-term efficacy, safety, and impact on
immunoglobulin G (
IgG) levels of
rituximab in patients with
myasthenia gravis (MG). A retrospective, observational study of drug-refractory MG patients treated with
rituximab was done. The MG Foundation of America postintervention status (MGFA-PIS) was used to evaluate clinical response. Serum
IgG levels were determined at baseline and post-treatment.
Hypogammaglobulinemia was defined as
IgG<7g/L. Thirty patients were included, 12 with anti-
MuSK and 18 with anti-AChR
antibodies. Mean (SD) follow-up was 85.5 (48) months. All 12 MuSK+ patients but only six (33%) AChR+ patients achieved minimal manifestations or remission (p<0.01). Nine severe
infections were observed in five patients (17%). One patient was diagnosed with
progressive multifocal leukoencephalopathy. At baseline, two patients (2/24; 8%) had
hypogammaglobulinemia. During follow-up,
hypogammaglobulinemia was observed in 60% (3/5) of patients who developed an
infection and in 33% (7/21) who did not. Two of these patients died of
infection-related complications. This study supports the effectiveness of
rituximab in patients with MG, especially those with
anti-MuSK antibodies. Severe
infections may appear after
rituximab treatment and
hypogammaglobulinemia might play a role on it. A standard protocol would be needed to closely monitor
IgG levels in MG patients treated with
rituximab.