Clinical neurology and neurosurgery · 2026
Individualized Ofatumumab versus Fixed Low-Dose Rituximab in MuSK-Antibody-Positive Myasthenia Gravis: A Multicenter Retrospective Cohort Study.
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Zhou Qian, Zhong Yi, Yin Weifan, Jiang Fei, Zeng Qiuming, Shi Guanzhong, Ouyang Yuzhen, He Ting, Dong Xiaohua, Wen Zeyi, Cai Haobing, Xiang Wei, Wang Liu, Li Kailin, Yang Huan
Аннотация
PURPOSE: This study aimed to compare the effectiveness and safety of ofatumumab (OFA) versus rituximab (RTX) in patients with muscle-specific kinase myasthenia gravis (MuSK-MG).
METHODS: This multicenter retrospective cohort study included 17 OFA-treated and 10 RTX-treated MuSK-MG patients from 3 centers. The individualized OFA protocol comprised induction (one or two 20 mg doses within 2 months), followed by maintenance dosing (20 mg) guided by CD19 + B-cell repopulation (≥5/µL) or clinical exacerbation. Over 6 months, the OFA group received a median cumulative dose of 60 mg (IQR 40-60). RTX-treated group used 600 mg. Primary endpoints included changes in QMG and MG-ADL scores from baseline to month 3 and month 6. Secondary endpoints covered prednisone reduction, 6-month minimal symptom expression (MSE) rate, time to MSE, early exacerbation, and safety.
RESULTS: Both agents achieved significant clinical improvement in QMG (p = 0.011) and MG-ADL (p < 0.001).OFA-treated patients showed progressive improvement through 6 months (ΔQMG: -8.45, ΔMG-ADL: -4.44), while RTX-treated patients presented early improvement at month 3 (ΔQMG: -4.42, ΔMG-ADL:-2.52) but attenuated by month 6 (ΔQMG: 0.01, ΔMG-ADL: -1.31), with a significant group × time interaction (ΔQMG p = 0.020). Prednisone‑sparing effect, 6‑month adjusted MSE rates, time to MSE, early exacerbation, and severe infection rates did not differ significantly between groups.
CONCLUSION: These hypothesis-generating observations suggest OFA, administered at this individualized dosing regimen, may be associated with more sustained 6-month responses than low-dose RTX, warranting validation in prospective controlled trials.
METHODS: This multicenter retrospective cohort study included 17 OFA-treated and 10 RTX-treated MuSK-MG patients from 3 centers. The individualized OFA protocol comprised induction (one or two 20 mg doses within 2 months), followed by maintenance dosing (20 mg) guided by CD19 + B-cell repopulation (≥5/µL) or clinical exacerbation. Over 6 months, the OFA group received a median cumulative dose of 60 mg (IQR 40-60). RTX-treated group used 600 mg. Primary endpoints included changes in QMG and MG-ADL scores from baseline to month 3 and month 6. Secondary endpoints covered prednisone reduction, 6-month minimal symptom expression (MSE) rate, time to MSE, early exacerbation, and safety.
RESULTS: Both agents achieved significant clinical improvement in QMG (p = 0.011) and MG-ADL (p < 0.001).OFA-treated patients showed progressive improvement through 6 months (ΔQMG: -8.45, ΔMG-ADL: -4.44), while RTX-treated patients presented early improvement at month 3 (ΔQMG: -4.42, ΔMG-ADL:-2.52) but attenuated by month 6 (ΔQMG: 0.01, ΔMG-ADL: -1.31), with a significant group × time interaction (ΔQMG p = 0.020). Prednisone‑sparing effect, 6‑month adjusted MSE rates, time to MSE, early exacerbation, and severe infection rates did not differ significantly between groups.
CONCLUSION: These hypothesis-generating observations suggest OFA, administered at this individualized dosing regimen, may be associated with more sustained 6-month responses than low-dose RTX, warranting validation in prospective controlled trials.