Myasthenia can be Treated With Drug Used for Rheumatoid Arthritis

Myasthenia gravis is an autoimmune disease that results in the loss of muscle control. It can worsen if it is not treated early with rituximab, a medication used to treat rheumatoid arthritis (RA). It is the finding of a randomized clinical investigation conducted by scientists at Sweden's Karolinska Institutet and reported in the journal JAMA Neurology. “Patients with new onset myasthenia who received rituximab as a complement to the standard of care showed greater improvement compared with patients who were given a placebo,” says Fredrik Piehl, professor at the Department of Clinical Neuroscience, Karolinska Institutet and the study’s principal investigator. “They also needed fewer adjuvant treatments and lower doses of cortisone than the placebo group. These are encouraging results that give hope for a more effective strategy for controlling new onset myasthenia more quickly, even if larger studies will be needed to assess the long-term effects of the treatment.”

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What is Myasthenia Gravis?

The immune system assaults the receptors between the muscles and the nerves in myasthenia gravis, leading to muscular weakness and exhaustion. It frequently begins near the muscles of the eyes before spreading to other body muscles. Since there is no cure for the disease, intervention focuses mostly on calming the immune system and managing the symptoms because it tends to progress in flare-ups. In Sweden, the condition affects about 25 per 100,000 people, primarily women.

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What is the Currently Available Treatment for Myasthenia Gravis?

There is just one drug approved to treat myasthenia- Soliris. However, it is expensive. Also, yet, no people in Sweden have benefited from it. Instead, many patients receive care from older, less-effective pill medications like corticosteroids, which can have side effects.

About 47 adult participants with a myasthenia diagnosis during the previous year were part of the current investigation. Roughly 25 people were randomly assigned to receive a single dose of the well-researched medication rituximab (500 mg), while 22 received a placebo. Patients in the trial were monitored for up to 48 weeks at seven clinics in Sweden.

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Benefits of Using Rituximab for the Treatment of Myasthenia Gravis

According to a trusted 13-item rating scale, after four months, 71% of the rituximab group had control of their condition, as opposed to 29% of the placebo group. The findings were similar from further follow-ups at six, nine and 12 months.

Additionally, the rituximab group required fewer adjuvant therapies and received lower corticosteroid dosages on average. However, they also reported more side effects, most of which were minor. One group member with a history of heart disease passed away from a myocardial infarction and cardiac arrest. During the research period, three individuals in the placebo group required hospital care, including two for potentially fatal ailments due to worsening of their myasthenia.

“The use of rituximab for myasthenia in Sweden increased even before the study results were finalized,” says Fredrik Piehl. “It is also a treatment that neurologists in Sweden are very familiar with thanks to the widespread and somewhat debated off-label prescribing for multiple sclerosis (MS). We’ll now, in a way like that with MS, analyze the long-term benefit-risk balance of the treatment with the help of national data collected via the Swedish myasthenia registry and national health registries. We also need to find markers that can predict the course of the disease at an early stage.”

Source-Medindia