Highlights
- •Peripheral neuropathy with anti-MAG monoclonal IgM may be improved by Rituximab.
- •Acute worsening after Rituximab has been reported in 10 cases including our 3 patients.
- •It may occur even in patients who have already received Rituximab without problem.
- •It is unpredictable and severe and recovery may not be complete.
- •This should be considered in making treatment decision.
Abstract
Background
Patients with peripheral neuropathy and anti-MAG monoclonal IgM may respond to Rituximab,
a humanized monoclonal anti-CD20 antibody.
Methods
We report on three patients with peripheral neuropathy and anti-MAG monoclonal IgM
who deteriorated under Rituximab and reviewed seven previously published cases.
Results
Worsening was acute and severe, and occurred during the treatment period. All the
patients improved after deterioration but at final evaluation only one was improved
comparatively to baseline, five were worsened and four were stabilized. Deterioration
was not clearly associated with an increase of the anti-MAG antibody titer. Two patients
received Rituximab prior or after the course which induced worsening without adverse
reaction.
Conclusion
Although rare, acute worsening of the neuropathy can occur after Rituximab. The deterioration
is however reversible within some weeks to several months.
Keywords
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Article info
Publication history
Published online: August 02, 2014
Accepted:
July 26,
2014
Received in revised form:
July 24,
2014
Received:
April 29,
2014
Identification
Copyright
© 2014 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
