Successful treatment of MuSK antibody-positive myasthenia gravis with rituximab

Muscle Nerve. 2006 Apr;33(4):575-80. doi: 10.1002/mus.20479.

Abstract

We report on a 56-year-old woman with muscle-specific receptor tyrosine kinase (MuSK) antibody-positive myasthenia with predominant bulbar symptoms and respiratory insufficiency. Conventional immunosuppression (prednisolone, azathioprine, mycophenolate mofetil) could not maintain the clinical improvement initially achieved by repeated plasma exchanges. Therefore, treatment with rituximab was initiated. After 2 months of rituximab treatment, remarkable clinical improvement correlating with a reduction of MuSK serum antibodies was seen. The patient continued to remain stable 12 months after initiation of therapy. This case report demonstrates that rituximab may be an effective and tolerable treatment in MuSK antibody-positive myasthenia gravis.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Hormones / adverse effects
  • Adrenal Cortex Hormones / therapeutic use
  • Anti-Inflammatory Agents / adverse effects
  • Anti-Inflammatory Agents / therapeutic use
  • Antibodies / analysis
  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Murine-Derived
  • B-Lymphocytes / immunology
  • B-Lymphocytes / metabolism
  • Female
  • Humans
  • Immunoglobulin G / metabolism
  • Immunoglobulin M / metabolism
  • Immunosuppressive Agents / therapeutic use
  • Middle Aged
  • Myasthenia Gravis / drug therapy*
  • Myasthenia Gravis / genetics
  • Myasthenia Gravis / immunology
  • Mycophenolic Acid / adverse effects
  • Mycophenolic Acid / analogs & derivatives
  • Mycophenolic Acid / therapeutic use
  • Plasma Exchange
  • Prednisolone / adverse effects
  • Prednisolone / therapeutic use
  • Receptor Protein-Tyrosine Kinases / genetics*
  • Receptor Protein-Tyrosine Kinases / immunology
  • Receptors, Cholinergic / genetics*
  • Receptors, Cholinergic / immunology
  • Rituximab
  • T-Lymphocytes / immunology
  • T-Lymphocytes / metabolism

Substances

  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • Antibodies
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Immunoglobulin G
  • Immunoglobulin M
  • Immunosuppressive Agents
  • Receptors, Cholinergic
  • Rituximab
  • Prednisolone
  • MUSK protein, human
  • Receptor Protein-Tyrosine Kinases
  • Mycophenolic Acid