Frontiers in Neurology (Sep 2024)
Efficacy and safety of low-dose rituximab in the treatment of myasthenia gravis: a systemic review and meta-analysis
Abstract
BackgroundRituximab (RTX) is a monoclonal antibody that has been increasingly used in the treatment of myasthenia gravis (MG). In most studies, the therapeutic protocol of RTX has been similar to that adopted for B cell lymphoma, with an increasing number of studies aimed at exploring the efficacy of low-dose RTX in MG. However, the beneficial effects of low-dose RTX in MG remain a subject of critical debate.MethodsThis study was conducted following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Two reviewers (Xishuai Yang and Bingxia Li) independently conducted searches across multiple databases, including PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library, and China National Knowledge Infrastructure (CNKI). A meta-analysis, utilizing representative forest plots, was performed to assess “Improved clinical status” and changes in the Quantitative Myasthenia Gravis (QMG) score before and after treatment.ResultsA total of 17 studies involving 292 patients were included in the meta-analysis. A noticeable improvement in clinical status was observed in 91% of patients at the final follow-up after therapy (95% CI: 84–96%, P < 0.001). The QMG score showed a significant reduction following the treatment, with a standardized mean difference (SMD) of −1.69 (95% CI: −2.21 to −1.16, Z = 6.29, P < 0.001). In the acetylcholine receptor antibody-positive myasthenia gravis (AChR-MG) group, 90% of patients achieved improved clinical status (95% CI: 80–97%, P < 0.001) and the QMG score significantly decreased after low-dose RTX treatment, with an SMD of −1.51 (95% CI: −0.80 to −2.21, Z = 4.50, P < 0.001). In the muscle-specific kinase antibody-positive myasthenia gravis (MuSK-MG) group, 97% of patients achieved improved clinical status (95% CI: 89–100%, P < 0.001). The QMG score also significantly decreased following low-dose RTX treatment, with an SMD of −2.31 (95% CI: −2.99 to −1.62, Z = 6.60, P < 0.001). Adverse effects were reported in 29 out of 207 patients (14%, including infusion reactions in 22 patients (10.1%), infections in three patients (1.45%), cytopenia in two patients (0.96%), eosinophilia in one patient (0.48%), and hemiplegia in one patient (0.48%). Additionally, one patient (0.48%) succumbed to complications from invasive thymoma.ConclusionOur meta-analysis shows that low-dose RTX is both effective and safe for treating MG.Systematic Review RegistrationPROSPERO, identifier: CRD42024509951.
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