{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:38:44Z","timestamp":1787071124280,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:p>\n                    Nearly 10%\u201315% patients with generalized myasthenia gravis (MG) have refractory disease and are candidates for newer nonconventional immunotherapies. Rituximab has emerged as an attractive option in them. We describe the efficacy and safety of rituximab in 12 patients with refractory MG treated over a period of 4 years in a tertiary care center. We had a female-predominant cohort (10 females) in the age range 10\u201367 years. There were eight seropositive patients (acetylcholine receptor, muscle-specific kinase, or both antibodies) and eight had undergone thymectomy. Median number of crises was 2 before treatment with rituximab. Sustained improvement at 12 months was seen in seven patients and steroid dose could be reduced in them. Four worsened on therapy (including one death following prolonged ventilation and septicemia). One patient who had no response to therapy was re-evaluated and diagnosed with congenital myasthenic syndrome related to biallelic\n                    <jats:italic toggle=\"yes\">CHRNE<\/jats:italic>\n                    mutation. In summary, nearly two-thirds (7\/11, 63.6%) of autoimmune refractory MG in this cohort showed a good response to rituximab.\n                  <\/jats:p>","DOI":"10.4103\/aian.aian_579_24","type":"journal-article","created":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T11:08:05Z","timestamp":1733137685000},"page":"706-709","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Rituximab in Refractory Myasthenia Gravis \u2013 Challenges and Lessons Learnt"],"prefix":"10.4103","volume":"27","author":[{"given":"Karthika A","family":"Valaparambil","sequence":"first","affiliation":[{"name":"Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soumya","family":"Sundaram","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sruthi S","family":"Nair","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,12,2]]},"reference":[{"key":"R1-20260424","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/S1474-4422(15)00145-3","article-title":"Myasthenia gravis: Subgroup classification and therapeutic strategies","volume":"14","author":"Gilhus","year":"2015","journal-title":"Lancet Neurol"},{"key":"R2-20260424","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":"R3-20260424","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":"R4-20260424","doi-asserted-by":"crossref","first-page":"736190","DOI":"10.3389\/fneur.2021.736190","article-title":"Effectiveness and safety of rituximab for refractory myasthenia gravis: A systematic review and single-arm meta-analysis","volume":"12","author":"Zhao","year":"2021","journal-title":"Front Neurol"},{"key":"R5-20260424","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":"R6-20260424","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":"R7-20260424","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":"R8-20260424","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":"R9-20260424","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":"R10-20260424","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1002\/mus.26790","article-title":"Low-dose rituximabevery 6 months for the treatment of acetylcholine receptor\u2013positive refractory generalized myasthenia gravis","volume":"61","author":"Lu","year":"2020","journal-title":"Muscle Nerve"},{"key":"R11-20260424","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1002\/mus.21521","article-title":"Rituximab in the management of refractory myasthenia gravis","volume":"41","author":"Zebardast","year":"2010","journal-title":"Muscle Nerve"},{"key":"R12-20260424","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1002\/acn3.52051","article-title":"Real-world experience with eculizumab and switching to ravulizumab for generalized myasthenia gravis","volume":"11","author":"Tokuyasu","year":"2024","journal-title":"Ann Clin Transl Neurol"},{"key":"R13-20260424","doi-asserted-by":"crossref","first-page":"e200276","DOI":"10.1212\/CPJ.0000000000200276","article-title":"Therapeutic responses to efgartigimod for generalized myasthenia gravis in Japan","volume":"14","author":"Suzuki","year":"2024","journal-title":"Neurol Clin Pract"},{"key":"R14-20260424","doi-asserted-by":"crossref","first-page":"25","DOI":"10.2147\/ITT.S377056","article-title":"Novel Immunotherapies for myasthenia gravis","volume":"12","author":"Nair","year":"2023","journal-title":"Immunotargets Ther"},{"key":"R15-20260424","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"}],"container-title":["Annals of Indian Academy of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aian.aian_579_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:41:49Z","timestamp":1787067709000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aian.aian_579_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11]]},"references-count":15,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/aian.aian_579_24","relation":{},"ISSN":["0972-2327","1998-3549"],"issn-type":[{"value":"0972-2327","type":"print"},{"value":"1998-3549","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11]]},"assertion":[{"value":"2024-07-21","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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