A Case of Myasthenia Gravis Treated with Ocrelizumab

Myasthenia gravis (MG) is an autoimmune disease affecting the neuromuscular junction, causing weakness. The mainstay of treatment is immune based. The muscle-specific tyrosine kinase (MuSK)-positive MG is different with regard to treatment, from acetylcholine receptor (AChR) antibody-positive and seronegative MG. Mostly, these are poorly responsive to anticholinesterase agents and thymectomy. Also they may remain steroid dependent despite the addition of azathioprine or mycophenolate mofetil. Rituximab is the preferred early therapy in these patients, especially if there is an unsatisfactory response to initial glucocorticoids. The use of newer anti-CD20 like ocrelizumab is not part of the current practice. They have the advantage of being fully-humanized and thus better tolerated. A case report along with literature review will be presented in a poster. A 35-year-old male with MuSK positive myasthenia gravis was put on rituximab. However, he developed infusion reactions and continued to have weakness. After discussing with him, we switched treatment to ocrelizumab. Patient is on ocrelizumab for more than 8 months now. He is clinically stable with no further exacerbation. The role of the new anti-CD20 agents along with or without anti-CD19 agents, is yet to be determined. Based on our observation, ocrelizumab carries potential benefits in anti-MuSK positive myasthenia gravis.