{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:32:12Z","timestamp":1787758332122,"version":"build-2784847793"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Myasthenia gravis (MG) is an immune-mediated disorder of the neuromuscular junction. About 10% are refractory to immunosuppressive therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims:<\/jats:title>\n                    <jats:p>To analyze the response of patients with generalized MG to rituximab.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Materials:<\/jats:title>\n                    <jats:p>\n                      A retrospective review of patients with MG who received rituximab was carried out (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 13, M:F = 6:7, mean age: 44.84 \u00b1 15.73 years). Myasthenia Gravis Foundation of America (MGFA), MGFA post-intervention status (MGFA-PIS), and Myasthenia Gravis Status and Treatment Intensity (MGSTI) were assessed before and after rituximab.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The duration of MG was 104.07 \u00b1 92.25 months. Before rituximab, the MGFA was IIA\/IIB\/IIIA\/IIIB\/IVB\/V in 1\/1\/2\/6\/2\/1 patients and MGSTI was four in eight patients and six in three patients. The mean duration of follow up was 20.92 \u00b1 14.06 months (range, 4 to 42 months). Dose reduction or discontinuation of cholinesterase inhibitors could be achieved 12 patients. Complete stable remission (CSR) and pharmacologic remission (PR) were achieved in one and four patients respectively and five patients had minimal manifestations. Most patients attained level 0, 1 or 2 MGSTI at last follow up. No rituximab infusion-related adverse events were noted. Three patients had exacerbation of MG between one to five weeks after rituximab administration. Three patients died, one each due to a cardiac event unrelated to MG or treatment, complications related to myasthenic crisis, and coronavirus disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Rituximab was effective in bringing about remission in MG and can be considered as a first-line agent. However, it has to be administered under close supervision as some patients develop exacerbation of MG akin to steroid-induced worsening.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/0028-3886.359277","type":"journal-article","created":{"date-parts":[[2022,11,1]],"date-time":"2022-11-01T03:31:06Z","timestamp":1667273466000},"page":"1931-1941","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Rituximab in Myasthenia Gravis- Experience from a Low- and Middle-Income Country (LMIC) Setting"],"prefix":"10.4103","volume":"70","author":[{"given":"Sumanth","family":"Shivaram","sequence":"first","affiliation":[{"name":"Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhu","family":"Nagappa","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nibu","family":"Varghese","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doniparthi V","family":"Seshagiri","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shishir","family":"Duble","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shreedhara Anjanapura","family":"Siddappa","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nagabushan","family":"Hesarur","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjib","family":"Sinha","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun B","family":"Taly","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,10,20]]},"reference":[{"key":"R1-20250926","doi-asserted-by":"crossref","first-page":"2820","DOI":"10.1080\/21645515.2018.1508624","article-title":"Anti-CD20 monoclonal antibodies: Reviewing a revolution","volume":"14","author":"Casan","year":"2018","journal-title":"Hum Vaccin Immunother"},{"key":"R2-20250926","first-page":"3147","article-title":"Serotherapy of a patient with a monoclonal antibody directed against a human lymphoma-associated antigen","volume":"40","author":"Nadler","year":"1980","journal-title":"Cancer Res"},{"key":"R3-20250926","doi-asserted-by":"crossref","first-page":"2729","DOI":"10.1111\/trf.14841","article-title":"Systematic review of rituximab for autoimmune diseases: A potential alternative to intravenous immune globulin","volume":"58","author":"MacIsaac","year":"2018","journal-title":"Transfusion"},{"key":"R4-20250926","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1136\/practneurol-2018-001899","article-title":"Rituximab in neurological disease: Principles, evidence and practice","volume":"19","author":"Whittam","year":"2019","journal-title":"Pract Neurol"},{"key":"R6-20250926","doi-asserted-by":"crossref","first-page":"577080","DOI":"10.1016\/j.jneuroim.2019.577080","article-title":"Myasthenia gravis: State of the art and new therapeutic strategies","volume":"337","author":"Souto","year":"2019","journal-title":"J Neuroimmunol"},{"key":"R7-20250926","doi-asserted-by":"crossref","first-page":"1756285617749134","DOI":"10.1177\/1756285617749134","article-title":"When myasthenia gravis is deemed refractory: Clinical signposts and treatment strategies","volume":"11","author":"Mantegazza","year":"2018","journal-title":"Ther Adv Neurol Disord"},{"key":"R8-20250926","doi-asserted-by":"crossref","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":"R9-20250926","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1111\/nyas.14195","article-title":"Myasthenia gravis and specific immunotherapy: Monoclonal antibodies","volume":"1452","author":"Cai","year":"2019","journal-title":"Ann N Y Acad Sci"},{"key":"R10-20250926","doi-asserted-by":"crossref","first-page":"116690","DOI":"10.1016\/j.jns.2020.116690","article-title":"Differential response to rituximab in anti-AChR and anti-MuSK positive myasthenia gravis patients: A single-center retrospective study","volume":"411","author":"Litchman","year":"2020","journal-title":"J Neurol Sci"},{"key":"R11-20250926","doi-asserted-by":"crossref","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":"R12-20250926","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1212\/WNL.0000000000004341","article-title":"Rituximab as treatment for anti-MuSK myasthenia gravis: Multicenter blinded prospective review","volume":"89","author":"Hehir","year":"2017","journal-title":"Neurology"},{"key":"R13-20250926","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1002\/ajh.20169","article-title":"Response of myasthenia gravis to rituximab in a patient with non-Hodgkin lymphoma","volume":"77","author":"Gajra","year":"2004","journal-title":"Am J Hematol"},{"key":"R14-20250926","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1212\/WNL.55.1.16","article-title":"Myasthenia gravis: Recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America","volume":"55","author":"Jaretzki","year":"2000","journal-title":"Neurology"},{"key":"R15-20250926","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1002\/mus.23412","article-title":"Rituximab in refractory and non-refractory myasthenia: A retrospective multicenter study","volume":"46","author":"Collongues","year":"2012","journal-title":"Muscle Nerve"},{"key":"R16-20250926","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.nmd.2016.12.004","article-title":"Resistant myasthenia gravis and rituximab: A monocentric retrospective study of 28 patients","volume":"27","author":"Afanasiev","year":"2017","journal-title":"Neuromuscul Disord"},{"key":"R17-20250926","doi-asserted-by":"crossref","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":"R18-20250926","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1007\/s00415-019-09191-6","article-title":"High efficacy of rituximab for myasthenia gravis: A comprehensive nationwide study in Austria","volume":"266","author":"Topakian","year":"2019","journal-title":"J Neurol"},{"key":"R19-20250926","doi-asserted-by":"crossref","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":"R20-20250926","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1136\/jnnp-2019-322606","article-title":"Rituximab in AChR subtype of myasthenia gravis: Systematic review","volume":"91","author":"Di Stefano","year":"2020","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"R21-20250926","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.nmd.2019.12.003","article-title":"Emerging therapies for autoimmune myasthenia gravis: Towards treatment without corticosteroids","volume":"30","author":"Tannemaat","year":"2020","journal-title":"Neuromuscul Disord"},{"key":"R22-20250926","doi-asserted-by":"crossref","first-page":"241","DOI":"10.3233\/JND-180300","article-title":"Efficacy of rituximab in refractory generalized anti-AChR Myasthenia Gravis","volume":"5","author":"Landon-Cardinal","year":"2018","journal-title":"J Neuromuscul Dis"},{"key":"R23-20250926","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1177\/1756285611411503","article-title":"Response of patients with refractory myasthenia gravis to rituximab: A retrospective study","volume":"4","author":"Nowak","year":"2011","journal-title":"Ther Adv Neurol Disord"},{"key":"R24-20250926","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1001\/jamaneurol.2016.4190","article-title":"Durability of the rituximab response in acetylcholine receptor autoantibody-positive myasthenia gravis","volume":"74","author":"Robeson","year":"2017","journal-title":"JAMA Neurol"},{"key":"R25-20250926","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.jns.2017.02.009","article-title":"10-year-outcomes after rituximab for myasthenia gravis: Efficacy, safety, costs of in-hospital care, and impact on childbearing potential","volume":"375","author":"Stieglbauer","year":"2017","journal-title":"J Neurol Sci"},{"key":"R26-20250926","doi-asserted-by":"crossref","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":"R27-20250926","doi-asserted-by":"crossref","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":"R28-20250926","doi-asserted-by":"crossref","first-page":"1756286419871187","DOI":"10.1177\/1756286419871187","article-title":"Repeated low-dose rituximab treatment based on the assessment of circulating B cells in patients with refractory myasthenia gravis","volume":"12","author":"Choi","year":"2019","journal-title":"Ther Adv Neurol Disord"},{"key":"R29-20250926","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.jneuroim.2019.05.004","article-title":"Effect of low-dose rituximab treatment on T- and B-cell lymphocyte imbalance in refractory myasthenia gravis","volume":"332","author":"Jing","year":"2019","journal-title":"J Neuroimmunol"},{"key":"R30-20250926","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1007\/s00415-019-09296-y","article-title":"Rituximab as induction therapy in refractory myasthenia gravis: 18 month follow-up study","volume":"266","author":"Singh","year":"2019","journal-title":"J Neurol"},{"key":"R31-20250926","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1002\/mus.26790","article-title":"Low-dose rituximab every 6 months for the treatment of acetylcholine receptor-positive refractory generalized myasthenia gravis","volume":"61","author":"Lu","year":"2020","journal-title":"Muscle Nerve"},{"key":"R32-20250926","doi-asserted-by":"crossref","first-page":"2277","DOI":"10.1111\/ene.14391","article-title":"Efficacy and safety of rituximab in myasthenia gravis: A French multicentre real-life study","volume":"27","author":"Dos Santos","year":"2020","journal-title":"Eur J Neurol"},{"key":"R33-20250926","doi-asserted-by":"crossref","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":"R34-20250926","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1001\/jamaneurol.2020.0851","article-title":"Comparison between rituximab treatment for new-onset generalized myasthenia gravis and refractory generalized myasthenia gravis","volume":"77","author":"Brauner","year":"2020","journal-title":"JAMA Neurol"},{"key":"R35-20250926","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1097\/WCO.0000000000000858","article-title":"Progress in the therapy of myasthenia gravis: Getting closer to effective targeted immunotherapies","volume":"33","author":"Dalakas","year":"2020","journal-title":"Curr Opin Neurol"},{"key":"R36-20250926","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1111\/j.1600-6143.2006.01288.x","article-title":"Rituximab, an anti-cd20 monoclonal antibody: History and mechanism of action","volume":"6","author":"Pescovitz","year":"2006","journal-title":"Am J Transplant"},{"key":"R37-20250926","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1136\/jnnp.2010.220475","article-title":"Use and monitoring of low dose rituximab in myasthenia gravis","volume":"82","author":"Blum","year":"2011","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"R38-20250926","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.jneuroim.2017.05.021","article-title":"Responsiveness to low-dose rituximab in refractory generalized myasthenia gravis","volume":"311","author":"Jing","year":"2017","journal-title":"J Neuroimmunol"},{"key":"R39-20250926","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1212\/WNL.0b013e3182a1aac7","article-title":"Responsiveness to reduced dosage of rituximab in Chinese patients with neuromyelitis optica","volume":"81","author":"Yang","year":"2013","journal-title":"Neurology"},{"key":"R40-20250926","doi-asserted-by":"crossref","first-page":"492","DOI":"10.4103\/0028-3886.144438","article-title":"Once myasthenic, always myasthenic? observations on the behavior and prognosis of myasthenia gravis in a cohort of 100 patients","volume":"62","author":"Khadilkar","year":"2014","journal-title":"Neurol India"},{"key":"R41-20250926","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1016\/j.nmd.2019.06.002","article-title":"Stopping oral steroid-sparing agents at initiation of rituximab in myasthenia gravis","volume":"29","author":"Roda","year":"2019","journal-title":"Neuromuscul Disord"},{"key":"R42-20250926","doi-asserted-by":"crossref","first-page":"4573","DOI":"10.1007\/s00415-020-10264-0","article-title":"Exacerbation of myasthenia gravis following corticosteroid treatment: What is the evidence? A systematic review","volume":"268","author":"Lotan","year":"2021","journal-title":"J Neurol"},{"key":"R43-20250926","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/j.jocn.2005.12.041","article-title":"Clinical predictors of steroid-induced exacerbation in myasthenia gravis","volume":"13","author":"Bae","year":"2006","journal-title":"J Clin Neurosci"},{"key":"R44-20250926","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1212\/NXI.0000000000000061","article-title":"Disease exacerbation after rituximab induction in neuromyelitis optica","volume":"2","author":"Perumal","year":"2015","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"R45-20250926","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.4103\/0028-3886.304128","article-title":"Respiratory 1. Assessment of Myasthenia Gravis Patients Using Repetitive Nerve Stimulation of Phrenic and Intercostal Nerves","volume":"68","author":"Pradhan","year":"2020","journal-title":"Neurol India"},{"key":"R46-20250926","doi-asserted-by":"crossref","first-page":"648","DOI":"10.4103\/0028-3886.289001","article-title":"Noninvasive Ventilation in Myasthenia Gravis","volume":"68","author":"Misra","year":"2020","journal-title":"Neurol India"},{"key":"R47-20250926","doi-asserted-by":"crossref","first-page":"528","DOI":"10.4103\/0028-3886.314552","article-title":"Myasthenia Gravis with Thymoma and a Rare Serological Profile-Report of a Case and Review of Literature","volume":"69","author":"Narasimhaiah","year":"2021","journal-title":"Neurol India"},{"key":"R48-20250926","doi-asserted-by":"crossref","first-page":"454","DOI":"10.4103\/0028-3886.284385","article-title":"Autologous stem cell transplant in adult multiple sclerosis patients: A study from North India","volume":"68","author":"Dayama","year":"2020","journal-title":"Neurol India"},{"key":"R49-20250926","doi-asserted-by":"crossref","first-page":"1772","DOI":"10.4103\/0028-3886.333460","article-title":"COVID-19 in Patients with Myasthenia Gravis: Mechanisms of Respiratory Failure","volume":"69","author":"Murthy","year":"2021","journal-title":"Neurol India"},{"key":"R50-20250926","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.4103\/0028-3886.299157","article-title":"Atypical Multiple Sclerosis with Antibody to MOG","volume":"68","author":"Dave","year":"2020","journal-title":"Neurol India"}],"container-title":["Neurology India"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/0028-3886.359277","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:12:59Z","timestamp":1787757179000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/0028-3886.359277"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9]]},"references-count":49,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.4103\/0028-3886.359277","relation":{},"ISSN":["0028-3886","1998-4022"],"issn-type":[{"value":"0028-3886","type":"print"},{"value":"1998-4022","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9]]},"assertion":[{"value":"2021-08-02","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-14","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}