全身型MGにおけるB細胞標的療法

抄録

Myasthenia gravis (MG) is an antibody–mediated autoimmune disorder characterized by impaired neuromuscular transmission, resulting in fluctuating muscle weakness and fatigability. Despite conventional immunosuppressive treatments, a substantial proportion of patients continue to experience inadequate symptom control. In this context, this review focuses on B cell–targeted therapy, which has been attracting attention as a novel therapeutic strategy for generalized MG. The pathogenic role of autoantibodies in MG has led to increasing interest in therapies that directly target B cells, the precursors of antibody–producing cells. We discuss three main categories of B cell–targeted approaches : monoclonal antibodies (with particular emphasis on rituximab), chimeric antigen receptor T cell therapies, and innovative Fc fusion proteins. Clinical trials and observational studies have demonstrated promising results for various B cell–targeted therapies. These findings are encouraging ; however, the optimal timing of intervention, patient selection criteria, and long–term safety profiles remain important considerations for clinical implementation. B cell–targeted therapies have not only expanded treatment options but also enhanced our understanding of MG pathogenesis and the immunological mechanisms underlying different disease subtypes. While challenges remain in therapeutic optimization, the ongoing development of increasingly selective B cell–targeting approaches offers new hope for improved disease management and potentially disease–modifying effects in generalized MG.