How does lack of success of rituximab treatment affect your decision to trial anti-CD19 therapies like inebilizumab?

I strongly believe that deeper and broader CD19 theraphy such as inebilizumab, works on a key different target: offering better disease control due to its broader B-cell targeting, as in CD19, plasmablasts, than rituximab, which targets CD20 (mature B cells), leading to more broad b cell depletion, hence working in those who have failed Rituxan. I am therefore likely to try it in MG patients who have failed CD20-targeted therapy.

N-MOmentum trial in NMSOD showed patients had fewer attacks on Uplizna after being switched from Rituximab.

Anti-CD19 therapies have a much broader range of action than anti-CD20s on the cascade of pro-B cells to mature plasma cells. It is therefore quite possible that a patient may respond to anti-CD19 treatment if they did not respond to anti-CD20. There may also be more risks with CD 20s, although the safety profile so far looks favorable. One of the issues with the effect of CD 20 is whether the patient has had an adequate trial. Some patients may need more than one round of treatment to see an effect. I have had patients with immune neuropathies not showing clinical benefit for over a year, but then showed impressive functional improvements after that.

One of the hopes with anti-CD19 treatments is that the effect on memory B cells and plasma...