Infections and hypogammaglobulinemia in myasthenia gravis patients receiving low-dose rituximab: a real-world cohort study - Report - MDSpire
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Infections and Hypogammaglobulinemia Among Myasthenia Gravis Patients on Long-Term Low-Dose Rituximab: Findings from a Retrospective Cohort Analysis

  • By

  • Rongjing Guo

  • Yifan Zhang

  • Ting Gao

  • Zhe Ruan

  • Chao Sun

  • Sijia Hao

  • Yonglan Tang

  • Qingqing Wang

  • Xiaoxi Huang

  • Xiangqi Cao

  • Zhuyi Li

  • Danni Liu

  • Yu Liu

  • Ting Chang

  • August 28, 2026

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Clinical Report: Infections and Hypogammaglobulinemia Among Myasthenia Gravis Patients

Overview

This study evaluates the incidence of infections and hypogammaglobulinemia (HGG) in myasthenia gravis patients receiving long-term low-dose rituximab.

Background

Myasthenia gravis (MG) is an autoimmune disorder characterized by muscle weakness due to impaired neuromuscular transmission. Rituximab (RTX) is increasingly used to treat MG, but its safety profile, particularly regarding infections and HGG, requires further investigation.

Data Highlights

ParameterValue
Patients in cohort186
Median age at RTX initiation52.50 years
Infection incidence15.59%
Severe infections11.29%
HGG incidence27.42%

Key Findings

  • Infections occurred in 15.59% of patients, primarily during the initial RTX cycle.
  • The median interval to the first infection episode was 170.37 days.
  • Lower respiratory tract infections accounted for 61.29% of infection episodes.
  • HGG was present in 27.42% of patients and was an independent predictor of infection (HR = 5.53).
  • Higher baseline prednisone doses increased the risk of severe lower respiratory tract infections (HR = 1.25).

Clinical Implications

Clinicians should monitor for infections, particularly lower respiratory tract infections, in myasthenia gravis patients receiving long-term low-dose rituximab. The presence of hypogammaglobulinemia should prompt careful consideration of infection prevention strategies.

Conclusion

The study highlights the relatively low incidence of infections in MG patients on low-dose rituximab, while emphasizing the significant risk posed by hypogammaglobulinemia.

Related Resources & Content

  1. Frontiers in Immunology, 2026 -- Infections and hypogammaglobulinemia in myasthenia gravis patients receiving low-dose rituximab: a real-world cohort study
  2. International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update - PMC
  3. Efficacy and Safety of Rituximab for New-Onset Generalized Myasthenia Gravis: The RINOMAX Randomized Clinical Trial - PMC
  4. Frontiers in Neurology — Assessment of Low-Dose Rituximab's Safety and Effectiveness in Patients with MuSK Antibody-Positive Myasthenia Gravis: A Retrospective Analysis from a Single Center
  5. Frontiers in Neurology — Rituximab in Myasthenia Gravis: a real-world study using inverse probability of treatment weighting
  6. Frontiers in Immunology — A predictive model for low-dose rituximab response in anti-acetylcholine receptor antibody-positive myasthenia gravis: establishment and validation
  7. Frontiers in Immunology — Rituximab is Associated with Accelerated Dialysis Independence in Anti-glomerular Basement Membrane Disease: A Retrospective Cohort Analysis of Renal Survival
  8. International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update - PMC
  9. Efficacy and Safety of Rituximab for New-Onset Generalized Myasthenia Gravis: The RINOMAX Randomized Clinical Trial - PMC
  10. Frontiers | Infections and hypogammaglobulinemia in myasthenia gravis patients receiving low-dose rituximab: a real-world cohort study

Original Source(s)

Infections and hypogammaglobulinemia in myasthenia gravis patients receiving low-dose rituximab: a real-world cohort study

  • by Rongjing Guo, Yifan Zhang, Ting Gao, Zhe Ruan, Chao Sun, Sijia Hao, Yonglan Tang, Qingqing Wang, Xiaoxi Huang, Xiangqi Cao, Zhuyi Li, Danni Liu, Yu Liu, Ting Chang

  • August 28, 2026

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