Rituximab in late-onset myasthenia gravis is safe and effective

Late-onset myasthenia gravis (LOMG; onset after 50 years of age) has different therapeutic decisionmaking challenges than MG in younger patients.

This is a retrospective series of seven patients with acetylcholine receptor antibody-positive MG, all treated with rituximab.

The mean age of onset was 66 years. Three patients were nonresponders to previous therapy and six had developed side effects to prednisone. All patients were treated with at least one dose of rituximab. The MG Foundation of America Post-Intervention Status ranged from MM-0 to MM-3 within a mean of 18.5 weeks. All patients were able to reduce or discontinue maintenance medications. No significant adverse events occurred.

This series highlights the safety and efficacy of rituximab in LOMG. The presence of multiple comorbidities and the risks of other immunotherapy in older patients makes rituximab an attractive option. More experience is needed to clarify the use of rituximab for patients in this age group.