Rituximab in MUSK-positive myasthenia: only choice without alternative?

Josef Finsterer, MD, PhD*, Carla A. Scorza, Ana C Fiorini, MD, Fulvio A. Scorza, MD, Ritwik Ghosh, MD

Rituximab in MUSK-positive myasthenia: only choice without alternative?

Josef Finsterer, MD, PhD*, Carla A. Scorza, Ana C Fiorini, MD, Fulvio A. Scorza, MD, Ritwik Ghosh, MD

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Josef Finsterer, MD, PhD*, Carla A. Scorza, Ana C Fiorini, MD, Fulvio A. Scorza, MD, Ritwik Ghosh, MD, “Rituximab in MUSK-positive myasthenia: only choice without alternative?”, ijmhs, vol. 10, no. 06, pp. 912–913, Jun. 2020.

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Abstract

With interest we read the article by Sachdeva et al. about
a study of six Indian patients with anti-muscle-specific tyrosine
kinase (MUSK) antibody-positive myasthenia gravis
who all profited f rom r ituximab i n m onotherapy o ver a
period of 8-24 months without side effects a fter treatment
with steroids, azathioprine, mycofenolate mofetil, cyclophosphamide,
intravenous immunoglobulins or plasma
exchange, failed to be effective [1]. The authors concluded
that rituximab is an effective i mmune-modulatory therapy
for MUSK antibody-positive myasthenia gravis patients
who were non-responsive to standard treatment. We have
the following comments and concerns.
According to table 1 in the report by Sachdeva et al.,
none of the six included patients, aged 32-58y, was reported
to have developed side effects during a follow-up period of
8-24 months [1]. Since rituximab is well-known for various
side effects i n v arious s ystems ( table 1 ), w e should
know if the six patients were asked for possible side effects
and prospectively investigated for them. Side effects
of rituximab previously reported include neuropathy, urinary
or bronchial infections, headache, gastrointestinal complaints,
acute thrombocytopenia, hypogammaglobulinemia,
leukopenia, ototoxicity, and several others (table 1).

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Issue Vol. 10 No. 06 (2020): Innovative Journal of Medical and Health Science
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Rituximab in MUSK-positive myasthenia: only choice without alternative?

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