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More than 20% of myasthenic patients are refractory to conventional treatments (plasma exchange, IVIg, steroids, azathioprine, mycophenolate mofetil). Rituximab (B\u2010lymphocyte\u2010depleting anti\u2010CD20) and apheresis (double\u2010filtration plasmapheresis [DFPP] and immunoadsorption [IA]) are interesting therapeutic alternatives.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This monocentric pilot study included nine refractory myasthenic patients (March 2018 to May 2020) treated by DFPP and\/or IA associated with rituximab (375\u2009mg\/m<jats:sup>2<\/jats:sup>). Clinical responses were assessed using the Myasthenia Gravis Foundation of America (MGFA) score.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Average age of patients was 53\u2009\u00b1\u200917\u2009years. Gender ratio (M\/F) was 3:6. The combination of apheresis and rituximab reduced median MGFA score from IV to II after 12\u2009months of follow\u2010up. Clinical improvement assessed by MGFA score was sustained in the long\u2010term for all patients, during an average follow\u2010up of 14\u2009\u00b1\u20099\u00a0months, allowing them to be self\u2010sufficient and out sick\u2010leave. The median number of apheresis sessions was 7 (5\u201030). The dose of prednisolone was reduced in two patients from 40\u2009mg\/d and 30\u2009mg\/d to 7.5\u00a0mg\/d and 10\u00a0mg\/d, respectively. It was stopped in a patient who was taking 30\u2009mg\/d. No infectious, bleeding, or thrombosis complications were noted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The combination of rituximab and DFPP was effective to treat refractory MG.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jca.21868","type":"journal-article","created":{"date-parts":[[2020,12,22]],"date-time":"2020-12-22T18:14:32Z","timestamp":1608660872000},"page":"348-363","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Treatment of refractory myasthenia gravis by double\u2010filtration plasmapheresis and rituximab: A case series of nine patients and literature review"],"prefix":"10.1002","volume":"36","author":[{"given":"Hamza N.","family":"Bennani","sequence":"first","affiliation":[{"name":"Service de N\u00e9phrologie, H\u00e9modialyse, Aph\u00e9r\u00e8ses et Transplantation R\u00e9nale CHU Grenoble  La Tronche 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