Evidence map›Paper›PMID 30649616›Full record

ArticleJournal of neurology2019

High efficacy of rituximab for myasthenia gravis: a comprehensive nationwide study in Austria.

Raffi Topakian, Fritz Zimprich, Stephan Iglseder, Norbert Embacher, Michael Guger, Karl Stieglbauer, Dieter Langenscheidt, Jakob Rath, Stefan Quasthoff, Philipp Simschitz and 8 more

Abstract read
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In one paragraph

Article in Journal of neurology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
53citing papers in PubMed, 4 pooled it
8.3field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

53 citing papers in PubMed, 4 syntheses or guidelines pooled it, 84 citations in OpenAlex.

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  5. Italian recommendations for the diagnosis and treatment of myasthenia gravis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors at 9 institutions in 1 country.

Raffi TopakianDepartment of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Grieskirchner Str. 42, 4600, Wels, Austria. raffi.topakian@hotmail.com.
Fritz ZimprichDepartment of Neurology, Medical University of Vienna, Vienna, Austria.
Stephan IglsederDepartment of Neurology, Krankenhaus Barmherzige Brüder, Linz, Austria.
Norbert EmbacherDepartment of Neurology, University Clinic St. Pölten, St. Pölten, Austria.
Michael GugerClinic for Neurology 2, Med Campus III, Kepler University Clinic, Linz, Austria.
Karl StieglbauerNeurologist in Private Practice, Linz, Austria.
Dieter LangenscheidtDepartment of Neurology, Landeskrankenhaus Rankweil, Rankweil, Austria.
Jakob RathDepartment of Neurology, Medical University of Vienna, Vienna, Austria.
Stefan QuasthoffDepartment of Neurology, Graz Medical University, Graz, Austria.
Philipp SimschitzDepartment of Neurology, Klinikum Klagenfurt, Klagenfurt, Austria.
Julia WanschitzDepartment of Neurology, Medical University Innsbruck, Innsbruck, Austria.
David WindischDepartment of Neurology, Landeskrankenhaus Bruck, Bruck, Austria.
Petra MüllerDepartment of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Grieskirchner Str. 42, 4600, Wels, Austria.
Dierk OelDepartment of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Grieskirchner Str. 42, 4600, Wels, Austria.
Günther SchusterederDepartment of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Grieskirchner Str. 42, 4600, Wels, Austria.
Stefan EinsiedlerDepartment of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Grieskirchner Str. 42, 4600, Wels, Austria.
Christian EggersDepartment of Neurology, Krankenhaus Barmherzige Brüder, Linz, Austria.
Wolfgang LöscherDepartment of Neurology, Medical University Innsbruck, Innsbruck, Austria.
Klinikum Wels-Grieskirchen · ATInnsbruck Medical University · ATLandeskrankenhaus Feldkirch · ATMedical University of Vienna · ATOrdensklinikum Linz Barmherzige Schwestern · ATKepler Universitätsklinikum · ATKlinikum Klagenfurt · ATMedical University of Graz · ATSt. Pölten University of Applied Sciences · AT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMost patients with myasthenia gravis (MG) need long-term immunosuppressive therapy. However, conventional agents may have intolerable side effects, take too long or fail to achieve disease control. Rituximab (RTX) has emerged as an off-label treatment for refractory MG, but data on its use are still sparse.

methodsWe conducted a retrospective nationwide study contacting all Austrian neurologists to provide anonymized data of all adult MG patients treated with RTX and minimum follow-up of 3 months. The Myasthenia Gravis Foundation of America Postintervention Status scale was used to assess outcomes.

results34 (60.7%) of a total of 56 patients were women. Median (IQR) age at diagnosis of MG and start of RTX were 41.5 (24.3; 65.8) and 47.5 (33; 71) years, respectively. Antibodies (ab) against acetylcholine receptor (AchR) and muscle-specific tyrosine kinase (MuSK) were present in 69.6% and 25% of patients, respectively (seronegative: 5.4%). Before RTX, 47 (83.9%) patients had had plasma exchange, immune adsorption or immunoglobulins. Three months after RTX, 14 of 53 (26.4%) patients were in remission. At last follow-up after a median of 20 (10; 53) months, remission was present in 42.9% of patients and another 25% had minimal manifestations. Remission was more frequent in patients with MuSK ab vs. those with AchR ab (71.4% vs. 35.9%, p = 0.022). RTX was safe. The presence of MuSK ab independently predicted remission after RTX.

conclusionIn this retrospective study on RTX for MG, the largest to date, RTX appeared safe, efficacious and fast acting. Benefit from RTX was greatest in MuSK ab + MG.

Indexed as

Treatment OutcomeAdultAgedAustriaCohort StudiesDose-Response Relationship, DrugFemaleHumansImmunologic FactorsLogistic ModelsMaleMiddle AgedMyasthenia GravisReceptor Protein-Tyrosine KinasesReceptors, CholinergicRituximabImmunologic FactorsMUSK protein, humanReceptor Protein-Tyrosine KinasesReceptors, CholinergicRituximabAnti-MuSKEfficacyMyasthenia gravisOutcomeRituximab

Identifiers

PMID30649616
OpenAlexW2909823939

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.