Efficacy and safety of rituximab in the treatment of refractory myasthenia gravis: Meta-analysis

Abstract

Objective To evaluate the efficacy and safety of rituximab (RTX) in the treatment of refractory myasthenia gravis (MG). Methods Retrieve relevant retrospective case analysis and observational studies that reported RTX therapy in patients with refractory MG from online databases (January 1, 2000-April 30, 2018) in PubMed, EMBASE/SCOPUS and Cochrane Online Library with key words: rituximab, myasthenia gravis. Quality of studies was evaluated by using Newcastle-Ottawa Scale (NOS). All data were pooled by Stata 12.0 software for Meta-analysis. Results A total of 1772 articles were enrolled, and 10 retrospective case analysis and one observational study with 160 eligible participants taking RTX were finally included after excluding duplicates and those not meeting the inclusion criteria. Among 160 patients, 88 were tested positive for acetylcholine receptor antibody (AChR- Ab+), 65 were tested positive for muscle-specific receptor tyrosine kinase antibody (MuSK-Ab+ ), and 7 were tested negative for two antibodies. Meta-analysis showed the overall effective rate of RTX treating refractory MG patients with serum AChR-Ab+ was 77% (95%CI: 0.642-0.899, P = 0.030); the overall effective rate of RTX treating refractory MG patients with serum MuSK-Ab+ was 73% (95%CI: 0.631-0.829, P = 0.048); RTX significantly reduced average daily dose of corticosteroids [before treatment 31.81 (20.00, 45.90) mg/d, after treatment 6.81 (3.44, 8.00) mg/d, decrement 21.70 (15.50, 42.46) mg/d; Z = 2.366, P = 0.018]; the main side effects of RTX were leukopenia, paroxysmal atrial fibrillation, infectious pneumonia, progressive multifocal leukoencephalopathy (PML), oral herpes zoster, et al. Conclusions Critical findings have been demonstrated in the evidence-based evaluation on efficacy and safety of RTX in the treatment of refractory MG. The effect of RTX on refractory MG is remarkable, and can significantly reduce the average daily dosage of corticosteroids. DOI: 10.3969/j.issn.1672-6731.2018.07.005

Keywords

• Myasthenia gravis
• Receptors, cholinergic
• Receptor protein ⁃ tyrosine kinases
• Meta⁃analysis