{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:19:03Z","timestamp":1787548743408,"version":"build-2736575974"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rituximab (RTX) is increasingly used for refractory myasthenia gravis (MG), particularly muscle-specific kinase antibody-positive MG (MuSK-MG). However, the optimal dosing regimen remains to be standardized, and conventional high-dose protocols may increase treatment burden, cumulative exposure, and infection-related concerns. This study evaluated the clinical efficacy, safety, and immunological effects of a low-dose RTX regimen in patients with MuSK-MG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 35 patients with MuSK-MG who received low-dose RTX at the First Affiliated Hospital of Guangzhou University of Chinese Medicine between January 1, 2017 and August 1, 2025. RTX was administered as 100\u202fmg on day 1 and 500\u202fmg on day 2, and the regimen was repeated every 6\u202fmonths. All patients received at least two treatment cycles. Clinical outcomes were assessed using Myasthenia Gravis Activities of Daily Living (MG-ADL) scores at baseline and at 3, 6, and 12\u202fmonths after treatment. Secondary outcomes included Myasthenia Gravis Foundation of America post-intervention status (MGFA-PIS), adverse events, and peripheral CD19+ B-cell percentages in 24 patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean baseline MG-ADL score was 9.5\u202f\u00b1\u202f5.6 and decreased to 2.1\u202f\u00b1\u202f2.3 at 3\u202fmonths, 1.0\u202f\u00b1\u202f1.8 at 6\u202fmonths, and 0.5\u202f\u00b1\u202f0.9 at 12\u202fmonths (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001 vs. baseline). At 3, 6, and 12\u202fmonths, 21 (60.0%), 25 (71.4%), and 28 (80.0%) patients achieved minimal manifestation status (MMS) or better was 6 months, respectively. Kaplan\u2013Meier analysis showed a median time to MMS or better of 6\u202fmonths. Both the bulbar involvement (BI) and non-bulbar involvement (non-BI) subgroups showed significant clinical improvement, although the trajectories of MG-ADL improvement differed between subgroups. In the 24 patients with available immunological data, the median CD19+ B-cell percentage decreased from 12.6% before treatment to 0.30% at 6\u202fmonths (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Adverse events were mild, and no serious infusion reactions, severe infections, or hepatic or renal dysfunction were observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Low-dose RTX was associated with rapid and sustained clinical improvement and effective peripheral B-cell depletion in patients with MuSK-MG, with acceptable tolerability. These findings support low-dose RTX as a potential therapeutic option for MuSK-MG, although prospective multicenter studies with standardized dosing and longer follow-up are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1929854","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T04:23:37Z","timestamp":1787545417000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of low-dose rituximab in MuSK antibody-positive myasthenia gravis: a single-center retrospective study"],"prefix":"10.3389","volume":"17","author":[{"given":"Li","family":"Yang","sequence":"first","affiliation":[{"name":"Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenyu","family":"Wu","sequence":"additional","affiliation":[{"name":"Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liqing","family":"Hu","sequence":"additional","affiliation":[{"name":"Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yufei","family":"Deng","sequence":"additional","affiliation":[{"name":"Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haocheng","family":"Luo","sequence":"additional","affiliation":[{"name":"Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuxiang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojun","family":"Yang","sequence":"additional","affiliation":[{"name":"Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiang","family":"Qilong","sequence":"additional","affiliation":[{"name":"Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1404191","DOI":"10.3389\/fimmu.2024.1404191","article-title":"Targeting autoimmune mechanisms by precision medicine in myasthenia gravis","volume":"15","author":"Cavalcante","year":"2024","journal-title":"Front Immunol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1038\/s41572-019-0079-y","article-title":"Myasthenia gravis","volume":"5","author":"Gilhus","year":"2019","journal-title":"Nat Rev Dis Primers"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"159","DOI":"10.3389\/fnmol.2020.00159","article-title":"Myasthenia gravis with antibodies against muscle-specific kinase: an update on clinical features, pathophysiology and treatment","volume":"13","author":"Cao","year":"2020","journal-title":"Front Mol Neurosci"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1111\/nyas.13518","article-title":"Myasthenia gravis with antibodies to MuSK: an update","volume":"1412","author":"Evoli","year":"2018","journal-title":"Ann N Y Acad Sci"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1038\/s41573-020-00092-2","article-title":"B cell depletion therapies in autoimmune disease: advances and mechanistic insights","volume":"20","author":"Lee","year":"2021","journal-title":"Nat Rev Drug Discov"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"49","DOI":"10.4103\/ijp.IJP_333_18","article-title":"Use of rituximab in muscle-specific tyrosine kinase antibody-positive myasthenia gravis: preliminary observations from a tertiary care center in Northern India","volume":"52","author":"Sachdeva","year":"2020","journal-title":"Indian J Pharmacol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1407","DOI":"10.1136\/jnnp-2012-303664","article-title":"Long-term benefit of rituximab in MuSK autoantibody myasthenia gravis patients","volume":"84","author":"Keung","year":"2013","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1002\/acn3.314","article-title":"Rituximab in refractory myasthenia gravis: a prospective, open-label study with long-term follow-up","volume":"3","author":"Anderson","year":"2016","journal-title":"Ann Clin Transl Neurol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1002\/mus.26156","article-title":"Rituximab in refractory myasthenia gravis: extended prospective study results","volume":"58","author":"Beecher","year":"2018","journal-title":"Muscle Nerve"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1136\/jnnp-2018-319410","article-title":"Long-term follow-up of patients with myasthenia gravis treated with low-dose rituximab","volume":"90","author":"Chan","year":"2019","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s40199-025-00557-y","article-title":"Efficacy and safety of different dosages of rituximab for myasthenia gravis: a single-arm meta-analysis","volume":"33","author":"Li","year":"2025","journal-title":"Daru"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"577528","DOI":"10.1016\/j.jneuroim.2021.577528","article-title":"Low-dose rituximab treatment for new-onset generalized myasthenia gravis","volume":"354","author":"Li","year":"2021","journal-title":"J Neuroimmunol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1097\/CND.0000000000000420","article-title":"Long-term remission with low-dose rituximab in myasthenia gravis: a retrospective study","volume":"24","author":"Castiglione","year":"2022","journal-title":"J Clin Neuromuscul Dis"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1016\/j.jaut.2016.11.005","article-title":"IgG4 autoantibodies against muscle-specific kinase undergo fab-arm exchange in myasthenia gravis patients","volume":"77","author":"Koneczny","year":"2017","journal-title":"J Autoimmun"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1260","DOI":"10.12688\/f1000research.8206.1","article-title":"Pathogenesis of myasthenia gravis: update on disease types, models, and mechanisms","volume":"5","author":"Phillips","year":"2016","journal-title":"F1000Res"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1212757","DOI":"10.3389\/fimmu.2023.1212757","article-title":"Immunotherapies in MuSK-positive myasthenia gravis: an IgG4 antibody-mediated disease","volume":"14","author":"Vakrakou","year":"2023","journal-title":"Front Immunol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1007\/s10072-021-05042-3","article-title":"AChRAb and MuSKAb double-seropositive myasthenia gravis: a distinct subtype?","volume":"42","author":"Zhang","year":"2021","journal-title":"Neurol Sci"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1275533","DOI":"10.3389\/fneur.2023.1275533","article-title":"Rituximab treatment in myasthenia gravis","volume":"14","author":"Vesperinas-Castro","year":"2023","journal-title":"Front Neurol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"953","DOI":"10.2147\/NDT.S358851","article-title":"Efficacy and safety of low-dose rituximab in anti-MuSK myasthenia gravis patients: a retrospective study","volume":"18","author":"Meng","year":"2022","journal-title":"Neuropsychiatr Dis Treat"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1439899","DOI":"10.3389\/fneur.2024.1439899","article-title":"Efficacy and safety of low-dose rituximab in the treatment of myasthenia gravis: a systematic review and meta-analysis","volume":"15","author":"Yang","year":"2024","journal-title":"Front Neurol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1002\/acn3.564","article-title":"The impact of rituximab infusion protocol on the long-term outcome in anti-MuSK myasthenia gravis","volume":"5","author":"Cort\u00e9s-Vicente","year":"2018","journal-title":"Ann Clin Transl Neurol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1016\/j.nmd.2022.06.006","article-title":"Rituximab in myasthenia gravis: efficacy, associated infections and risk of induced hypogammaglobulinemia","volume":"32","author":"Caballero-\u00c1vila","year":"2022","journal-title":"Neuromuscul Disord"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1212\/WNL.0000000000011124","article-title":"International consensus guidance for management of myasthenia gravis: 2020 update","volume":"96","author":"Narayanaswami","year":"2021","journal-title":"Neurology"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1007\/s00415-014-7532-3","article-title":"Efficacy and safety of rituximab for myasthenia gravis: a systematic review and meta-analysis","volume":"262","author":"Iorio","year":"2015","journal-title":"J Neurol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1002\/mus.25597","article-title":"Rituximab treatment of myasthenia gravis: a systematic review","volume":"56","author":"Tandan","year":"2017","journal-title":"Muscle Nerve"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"2989","DOI":"10.1007\/s11845-024-03763-w","article-title":"Clinical and laboratory remission with rituximab in anti-MuSK-positive myasthenia gravis","volume":"193","author":"Inan","year":"2024","journal-title":"Ir J Med Sci"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2235","DOI":"10.3390\/jcm10112235","article-title":"Myasthenia gravis: epidemiology, pathophysiology and clinical manifestations","volume":"10","author":"Dresser","year":"2021","journal-title":"J Clin Med"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1502480","DOI":"10.3389\/fimmu.2024.1502480","article-title":"A clinical perspective on muscle-specific kinase antibody-positive myasthenia gravis","volume":"15","author":"Keritam","year":"2024","journal-title":"Front Immunol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"556","DOI":"10.3390\/cells13060556","article-title":"MuSK myasthenia gravis: potential pathomechanisms and treatment directed against specific targets","volume":"13","author":"Dziadkowiak","year":"2024","journal-title":"Cells"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1007\/s00415-025-13504-3","article-title":"The overlooked side of myasthenia gravis: the non-motor manifestations\u2014a comprehensive review","volume":"272","author":"Messina","year":"2025","journal-title":"J Neurol"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1929854\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T04:23:38Z","timestamp":1787545418000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1929854\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":30,"alternative-id":["10.3389\/fneur.2026.1929854"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1929854","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"article-number":"1929854"}}