Article

Rituximab in the management of refractory myasthenia gravis.

Department of Neurology, Yale University School of Medicine, 40 Temple Street, Suite 6C, New Haven, Connecticut 06510, USA.
Muscle & Nerve (Impact Factor: 2.31). 10/2009; 41(3):375-8. DOI: 10.1002/mus.21521
Source: PubMed

ABSTRACT Myasthenia gravis (MG) is an immune-mediated disorder with a variable response to treatment. In this study, patients with refractory MG who were treated with rituximab were identified. A review of patients referred to the Yale Neuromuscular Clinic was performed. Patients with refractory MG who were treated with rituximab were reviewed for response to treatment. Patients who had muscle-specific kinase (MuSK(+)) or acetylcholine receptor (AChR(+)) antibodies were included. Six patients were identified who met the criteria described. All patients tolerated rituximab without side effects and had a reduced need for immunosuppressants and/or improvement in clinical function. Patients with refractory MG appeared to respond to rituximab in this small, retrospective study. This result suggests that a larger, prospective trial is indicated.

1 Bookmark
 · 
552 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This article provides a thorough overview of the current advances in diagnosis and therapy of myasthenia gravis (MG). Nowadays the term 'myasthenia gravis' includes heterogeneous autoimmune diseases with a postsynaptic defect of neuromuscular transmission as the common feature. Myasthenia gravis should be classified according to the antibody specificity (acetylcholine, MuSK, LRP4, seronegative), thymus histology (thymitis, thymoma, atrophy), age at onset (in children; < or > 40 years), and type of course (ocular or generalized). With optimal treatment, the prognosis is good in terms of daily functions, quality of life and survival. Symptomatic treatment with acetylcholine esterase inhibition is usually combined with immunosuppression. Azathioprine remains still the first choice for long-term immunosuppressive therapy. Alternative immunosuppressive options to azathioprine include ciclosporin, cyclophosphamide, methotrexate, mycophenolate mofetil, and tacrolimus. Rituximab is a promising new drug for severe generalized MG. Emerging therapy options include belimumab, eculizumab, and the granulocyte macrophage-colony-stimulating factor. One pilot study on etanercept has given disappointing results. For decades thymectomy has been performed in younger adults to improve non-paraneoplastic MG. However, controlled prospective studies on the suspected benefit of this surgical procedure are still lacking. In acute exacerbations including myasthenic crisis, intravenous immunoglobulin, plasmapheresis, and immunoadsorption are similarly effective.
    Clinical & Experimental Immunology 10/2013; · 3.28 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Myasthenia gravis (MG) is the most common disorder of neuromuscular transmission and is a prototypical autoimmune disorder. Most patients with MG are successfully treated with acetylcholinesterase inhibitors, corticosteroids, and/or steroid sparing agents such as azathioprine and mycophenolate mofetil. There is a small subset of patients, however, with treatment-refractory disease. In these cases, medications such as rituximab, high-dose cyclophosphamide, and eculizumab may be used. Thymectomy (in some cases repeat thymectomy) is another option in selected patients. Studies evaluating these and other forms of therapy in treatment-refractory MG are reviewed.
    Journal of Clinical Neuromuscular Disease 06/2014; 15(4):167-78.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The miniaturization of CMOS technology has reached a scale at which server processors are starting to integrate multi-gigabit network interface controllers (NIC). While transistors are becoming cheap and abundant in solid-state circuits, they remain at a premium on a processor die if they do not contribute to increase the number of cores and caches. Therefore, an integrated NIC (iNIC) must provide high networking performance under high logic density and low power dissipation. This paper describes the design of an integrated accelerator to offload computation-intensive protocol-processing tasks. The accelerator combines the concepts of the transport-triggered architecture with a programmable finite-state machine to deliver high instruction-level parallelism, efficient multiway branching and flexibility. The flexibility is key to adapt to protocol changes and address new applications. This accelerator was used in the construction of a 10 GbE iNIC in 45-nm CMOS technology. The ratio of performance (15 Mfps - 20 Gb/s Tput per port) to area (0.7 mm2) and the power consumption (0.15 W) of this accelerator were core enablers for constructing a processor compute complex with four iNICs.
    IEEE 20th Annual Symposium on High-Performance Interconnects, HOTI 2012, Santa Clara, CA, USA; 08/2012

Preview

Download
20 Downloads
Available from