Early use of low dose rituximab in anti acetylcholine receptor generalized myasthenia gravis in South Wales – A retrospective study

Background Early B-cell depletion with rituximab may improve outcomes in acetylcholine receptor (AChR)–positive generalized myasthenia gravis (MG), but data on early low-dose use are limited. Objective To assess the effectiveness, steroid-sparing effect, and safety of early low-dose rituximab in non-thymomatous, immunosuppression-naïve generalized AChR-positive MG. Methods Retrospective cohort from South Wales, UK. Adults with generalized AChR-positive MG within 12 months of generalization received a single 500 mg rituximab infusion. Outcomes at 3, 6, 12 and > 12 months included MGFA class, Activities of Daily Living (ADL), rescue therapies, prednisolone dose, and adverse events. Results Seventeen patients were treated. Female to male ratio was 5:12, median age of 71 years, and median duration of generalized symptoms before rituximab was 5 months. The majority of the baseline illness was MGFA IIIb–IVb. MGFA scores improved quickly: at 3 months, 14/17 patients were class Ia . At three months, prednisolone dropped from a median of 40 mg to 20 mg, then to 9.5 mg at six months, 5 mg at twelve months, and finally to 0 mg after twelve months. Complete disease remission without on-going treatment, namely steroids, other immunosuppression or acetylcholinesterase inhibitors, was attained by six cases. Conclusions In AChR-positive generalized MG, early low-dose rituximab was linked to significant steroid sparing, frequent remission, and quick clinical improvement, all of which highlight the need for more research on early low-dose approaches.