Rituximab for myasthenia gravis.

Area of Science:

• Autoimmune diseases
• Neuromuscular disorders
• Pharmacological interventions

Background:

• Myasthenia gravis (MG) is an autoimmune condition causing muscle weakness due to impaired neuromuscular transmission.
• Rituximab is increasingly used for MG, but its efficacy, optimal dosing, and patient subgroups benefiting remain unclear.
• High-quality evidence is needed to integrate rituximab into MG treatment algorithms.

Purpose of the Study:

• To assess the effects of rituximab, including biosimilar variants, in adult patients with myasthenia gravis.
• To evaluate the benefits and harms of rituximab across different patient subgroups and treatment strategies.
• To inform clinical decision-making and healthcare policy regarding rituximab use in MG.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs.
• Searched multiple databases (CENTRAL, MEDLINE, Embase) and trials registries up to November 2024.
• Included adults (≥16 years) with MG, comparing rituximab to placebo, no treatment, or alternative therapies.

Main Results:

• Two RCTs with 99 participants were included, with differing rituximab dosing strategies.
• Rituximab likely reduces relapses requiring rescue therapy over nine months (moderate-certainty evidence).
• Long-term effects on symptom severity, functional ability, and serious adverse events are uncertain (very low-certainty evidence).

Conclusions:

• Long-term efficacy of rituximab for symptom severity and functional ability in MG is uncertain.
• Rituximab shows little to no steroid-sparing effect but significantly reduces relapses over nine months.
• Insufficient data exist to determine optimal dosing or patient characteristics; further research is warranted.