{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T02:45:38Z","timestamp":1791859538271,"version":"4.3.4"},"reference-count":37,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2022YFC3501304"],"award-info":[{"award-number":["2022YFC3501304"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82271378"],"award-info":[{"award-number":["82271378"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction\/Aims<\/jats:title>\n                    <jats:p>Refractory pediatric ocular myasthenia gravis (OMG) remains difficult to manage. We evaluated tocilizumab's efficacy and safety in these patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single\u2010center, retrospective analysis of prospectively collected registry data from Tangdu Hospital (China), pediatric refractory OMG patients received intravenous tocilizumab (8\u2009mg\/kg every 4\u2009weeks) for 16\u2009weeks as add\u2010on therapy. Refractory disease required persistent symptoms despite adequate trials of \u2265\u20092 immunosuppressants, frequent relapses during glucocorticoid tapering, or intolerance of conventional oral immunosuppressants. The primary outcome was change in Myasthenia Gravis\u2010Activities of Daily Living (MG\u2010ADL) score from baseline to Weeks 4, 8, 12, and 16, analyzed using generalized estimating equations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All 10 patients (1 male, 9 females; median age 5.5\u2009years, range 2\u201311) completed 16\u2009weeks of follow\u2010up. Seven (70%) were positive for antiacetylcholine receptor antibody (AChR\u2010Ab). At Week 4, mean MG\u2010ADL score decreased from 3.4 to 2.5 (incidence rate ratio[IRR], 0.74; 95% CI, 0.54\u20130.99;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.048), with further reduction to 1.5 at week 16 (IRR, 0.44; 95% CI, 0.24\u20130.80;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007). Similarly, mean Quantitative MG (QMG) score dropped from 4.7 at baseline to 3.0 at Week 4 (IRR, 0.64; 95% CI, 0.41\u20130.99;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.048) and further to 1.9 at Week 16 (IRR, 0.40; 95% CI, 0.24\u20130.69;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). By Week 16, 50% of patients achieved minimal symptom expression, and 50% reduced prednisone requirements. Tocilizumab was well\u2010tolerated with only one transient infusion\u2010related dizziness.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>These preliminary findings suggest that tocilizumab may offer a safe and effective treatment option for children with refractory OMG.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mus.70435","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T01:55:26Z","timestamp":1791856526000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Efficacy and Safety of Tocilizumab in the Treatment of Refractory Ocular Myasthenia Gravis in Pediatric Patients"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5837-5831","authenticated-orcid":false,"given":"Qing\u2010Qing","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Neurology Tangdu Hospital, the Fourth Military Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9962-7082","authenticated-orcid":false,"given":"Xiang\u2010Qi","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Neurology Tangdu Hospital, the Fourth Military Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4828-9536","authenticated-orcid":false,"given":"Bi\u2010Ying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology Tangdu Hospital, the Fourth Military Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao\u2010Xi","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurology Tangdu Hospital, the Fourth Military Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7884-0438","authenticated-orcid":false,"given":"Si\u2010Jia","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Neurology Tangdu Hospital, the Fourth Military Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7546-8017","authenticated-orcid":false,"given":"Ting","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Neurology Tangdu Hospital, the Fourth Military Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8190-4022","authenticated-orcid":false,"given":"Zhe","family":"Ruan","sequence":"additional","affiliation":[{"name":"Department of Neurology Tangdu Hospital, the Fourth Military Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"issue":"5","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S1474-4422(09)70063-8","article-title":"Autoimmune Myasthenia Gravis: Emerging Clinical and Biological Heterogeneity","volume":"8","author":"Meriggioli M. 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