[pubmed] Retrospective Analysis of Safety and Outcomes of Rituximab for Myasthenia Gravis in Patients 65 Years Old

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Muscle Nerve. 2021 Aug 11. doi: 10.1002/mus.27393. Online ahead of print.

ABSTRACT

INTRODUCTION/AIMS: Optimal management of myasthenia gravis (MG) in individuals ≥ 65 years old is unknown and patient factors may limit therapeutic choices. Safety and efficacy of rituximab in older patients with MG has not been well-studied.

METHODS: This retrospective study examined 40 patients (14 patients ≥ 65 years old) treated with rituximab for MG. The primary efficacy outcome was the proportion of patients reaching "Improved" or better on Myasthenia Gravis Foundation of America (MGFA) Post-Intervention Status (PIS) at 12 months, compared between younger and older patients.

RESULTS: Ninety-two percent of patients ≥ 65 years old achieved MGFA PIS Improved or better at 12 months compared to 69% of those < 65 years old (p=0.11). Median prednisone dose for the cohort decreased in the year following rituximab initiation (20 mg [IQR 10-35] to 10mg [0-13], p=0.01). Non-refractory MG was predictive of favorable outcome, whereas age was not. Serious adverse events (SAEs) were similar between older and younger patients (21.4% vs. 30.8%, p=0.715). No patients ≥ 65 years old required discontinuation of rituximab due to SAE. One death occurred in a patient < 65 years old due to systemic inflammatory response syndrome.

DISCUSSION: At 12 months following initiation of rituximab for MG, patients ≥ 65 years old experienced similarly high rates of improvement in their myasthenic symptoms as younger patients, without an increased risk of experiencing SAEs. Rituximab should be considered in the treatment paradigm in older patients and in non-refractory MG patients of any age.

PMID:34378210 | DOI:10.1002/mus.27393


Source: https://pubmed.ncbi.nlm.nih.gov/3437821 ... 9&v=2.14.5