Rituximab for the Treatment of Myasthenia Gravis: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Key Message

Evidence from two systematic reviews of non-randomized studies, and 11 non-randomized studies suggests that rituximab treatment offers some clinical benefit to adult patients with refractory myasthenia gravis (MG). The MuSK MG subgroup appeared to experience greater clinical benefit compared to the AChR MG subgroup. Quality of life was reported in a few studies and there was suggestion of improvement with rituximab treatment. Rituximab treatment resulted in reduction in prednisone use. Antibody levels were reduced after rituximab treatment. Generally, side effects with rituximab were few and were not serious. Findings need to be interpreted in the light of limitations particularly the low quality of the studies, and small sample sizes.No relevant studies were identified that exclusively examined rituximab retreatment for the treatment of MG.No relevant studies were identified that exclusively examined rituximab maintenance therapy for the treatment of MG.No relevant study on the cost-effectiveness of rituximab therapy versus other therapies for the treatment of MG was identified.One evidence-based guideline regarding management of MG mentioned rituximab therapy as a treatment option; however, authors of the guideline cautioned readers as to the uncertainty of the evidence which prevented a formal consensus on the recommendations presented.