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Myasthenia GravisPhase 2NCT02110706

BeatMG: Phase II Trial of Rituximab In Myasthenia Gravis

A Phase 2 study testing Rituximab in people with Myasthenia Gravis, run by Yale University at 26 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

The specific primary objective of this study is to determine whether rituximab is a safe and beneficial therapeutic for Myasthenia Gravis (MG) that warrants further study in a phase III efficacy trial. Read more about this study

Who is it for?
Ages 21 to 90 years
Conditions the study is for
Myasthenia Gravis
What is being tested?
Rituximab
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
52 participants
Where
26 sitesUnited States
Study dates
May 2014to May 2018
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 21 to 90 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Subjects 21 to 90 years old
  • Subjects must have generalized MG, defined as MGFA clinical classification grades 2 (mild), 3 (moderate), or 4 (severe, but not intubated) at the time of screening/randomization.
  • Elevated AChR antibody titer
  • Subject's signs and symptoms should not be better explained by another disease process.
  • Subjects must be on a stable standard immunosuppressive regimen:
  • Prednisone only: Prednisone dose must be at least 15mg/day (or the equivalent on alternate days), and the dose of prednisone must have been stable for at least 4 weeks (28 days) prior to the baseline visit.
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  • Prednisone plus another immunosuppressive therapy (IST). Immunosuppressive therapies other than prednisone, specifically azathioprine, mycophenolate mofetil, cyclosporine, tacrolimus or methotrexate, are permitted, but the dose must have been stable for at least 6 months prior to the baseline visit.
  • (Note: The prednisone dose must be stable as defined in the prednisone only group. The IST dose must remain stable throughout the course of the study).
  • Subjects must be willing to complete the study and return for follow-up visits.
  • No history of thymoma, tumor, infection, or interstitial lung disease on chest CT, MRI, or chest x-ray. Note: Chest x-ray will be completed at screening to look of interstitial lung disease. A chest CT or MRI to evaluate for thymoma must be completed as part of prescreening.
  • Able and willing to give written informed consent and comply with the requirements of the study protocol.
  • Subjects must be able to give written informed consent before participating in this study. A copy of the signed consent must be kept in the subject's medical record.
  • Men and women of reproductive potential must agree to use an acceptable method of birth control during treatment and for twelve months (1 year) after completion of treatment.

Who cannot join

  • A history of chronic degenerative, psychiatric, or neurologic disorder other than MG that can produce weakness or fatigue.
  • Other major chronic or debilitating illnesses within six months prior to study entry.
  • Female subjects who are premenopausal and are:
  • pregnant on the basis of a serum pregnancy test,
  • breast-feeding, or
  • not using an effective method of double barrier (1 hormonal plus 1 barrier method or 2 simultaneous barrier methods) or birth control (birth control pills, male condom, female condom, intrauterine device, Norplant, tubal ligation, or other sterilization procedures).
Show all 38Show fewer
  • Altered levels of consciousness, dementia, or abnormal mental status.
  • Thymectomy in the previous six months.
  • Subjects who have been medicated with immunosuppressive drugs not listed in inclusion #5 within the last 8 weeks (56 days) prior to the baseline visit
  • Subjects who have been medicated with an immunosuppressive agent such as azathioprine, mycophenolate mofetil, cyclosporine, tacrolimus or methotrexate, that is withdrawn within 8 weeks (56 days) of the Baseline Visit.
  • Subjects who have received IVIg or PLEX treatment within the last 4 weeks (28 days) prior to the baseline visit.
  • Unstable dose or a stable dose of > 480 mg/day of pyridostigmine in 2 weeks prior to screening visit.
  • Daily use of non-steroidal anti-inflammatory drugs (NSAIDs).
  • History of renal or hepatic insufficiency or elevated liver enzymes (AST or ALT >2.5 x Upper Limit of Normal).
  • History of bone marrow hypoplasia, leucopenia, thrombocytopenia, significant anemia, clinical or laboratory evidence of immunodeficiency syndromes.
  • Forced Vital Capacity (FVC) <50% of percent predicted.
  • General Safety \& Laboratory Exclusion Criteria
  • ANC < 1.5 x 103 cells/microliter
  • Hemoglobin: < 8.0 gm/dL
  • Platelets: < 100,000/mm
  • Positive Hepatitis B or C serology (Hep B surface antigen and Hep C antibody)
  • History of positive HIV (HIV conducted during screening if applicable)
  • Treatment with any investigational agent within 4 weeks of screening or 5 half-lives of the investigational drug (whichever is longer)
  • Receipt of a live vaccine within 4 weeks prior to randomization
  • Previous treatment with rituximab (MabThera® / Rituxan®)
  • Previous treatment with natalizumab (Tysabri®)
  • History of severe allergic or anaphylactic reactions to humanized or murine monoclonal antibodies
  • History of recurrent significant infection or history of recurrent bacterial infections
  • Known active bacterial, viral fungal mycobacterial, or other infection (including tuberculosis or atypical mycobacterial disease, but excluding fungal infections of nail beds) or any major episode of infection requiring hospitalization or treatment with IV antibiotics within 4 weeks of screening or oral antibiotics within 2 weeks prior to screening
  • Unstable steroid dose in the past 4 weeks (28 days)
  • Lack of peripheral venous access
  • History of drug, alcohol, or chemical abuse within 6 months prior to screening
  • Concomitant malignancies or previous malignancies, with the exception of adequately treated basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix or prostate.
  • History of psychiatric disorder that would interfere with normal participation in this protocol
  • Significant cardiac or pulmonary disease (including obstructive pulmonary disease)
  • Any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that may affect the interpretation of the results or render the subject at high risk from treatment complications
  • Subjects that do not record daily prednisone doses for at least 28 days before the Baseline Visit, or subjects whose prednisone dose varies by ≥6mg/day on average.
  • Prednisone dose of more than 100 mg/day (or 200 mg over a two day period).

Trial locations and contacts

26 sites in 1 country.

26 sites in 1 country

United States26 sites
  • Emory University

    Atlanta, Georgia, 30322

  • University of Alabama at Birmingham

    Birmingham, Alabama, 35233

  • Brigham & Women's Hospital

    Boston, Massachusetts, 02115

  • SUNY Downstate Medical Center

    Brooklyn, New York, 11203

  • SUNY Buffalo

    Buffalo, New York, 14260

  • University of Virginia

    Charlottesville, Virginia, 22904

  • University of Cincinnati

    Cincinnati, Ohio, 45220

  • Ohio State University

    Columbus, Ohio, 43210

  • University of Texas Southwestern Medical Center

    Dallas, Texas, 75235

  • University of California - Davis

    Davis, California, 95616

  • University of Colorado - Denver

    Denver, Colorado, 80217

  • Northwestern University

    Evanston, Illinois, 60208

  • University of Kansas Medical Center

    Kansas City, Kansas, 66160

  • University of California - Los Angeles

    Los Angeles, California, 90095

  • University of Miami School of Medicine

    Miami, Florida, 33136

  • Yale School of Medicine, Department of Neurology

    New Haven, Connecticut, 06510

  • Columbia University Medical Center

    New York, New York, 10032

  • Weill Cornell Medical Center

    New York, New York, 10065

  • University of Pittsburgh

    Pittsburgh, Pennsylvania, 15260

  • Oregon Health and Science University

    Portland, Oregon, 97239

  • University of Rochester

    Rochester, New York, 14627

  • University of Utah

    Salt Lake City, Utah, 84112

  • Swedish Medical Center

    Seattle, Washington, 98107

  • Washington University

    St Louis, Missouri, 63130

  • SUNY Stony Brook

    Stony Brook, New York, 11790

  • Montefiore Medical Center

    The Bronx, New York, 10461

Other trials in United States

About this study

Official title: B Cell Targeted Treatment In Myasthenia Gravis (BeatMG): A Phase II Trial of Rituximab In Myasthenia Gravis

The specific primary objective of this study is to determine whether rituximab is a safe and beneficial therapeutic for Myasthenia Gravis (MG) that warrants further study in a phase III efficacy trial.

Read the detailed description

Investigators plan on conducting a multicenter randomized, double-blind, placebo controlled Phase II clinical trial utilizing a futility design. The study would include acetylcholine receptor (AChR) antibody positive generalized MG subjects. This study also presents a unique opportunity to study both drug and disease mechanisms because unlike many other autoimmune diseases in which rituximab has been used, MG affords the investigation of antigen-specific components that participate in the immunopathology of the disease, namely autoantibodies, autoantibody-producing B cells, and antigen-specific T cells. This work will further our understanding of MG immunopathology and it represents the first step toward gaining a more complete understanding of the immune mechanisms underlying treatment of MG with rituximab leading to new ways to treat the disease.

The specific aim of this study is to determine whether rituximab is a safe and effective treatment for subjects with MG.

The SNOMED code for MG is 31839002.

Being tested
Rituximab, Placebo
Keywords
Myasthenia Gravis, Rituximab, SNOMED code 31839002
Medical subject headings
Myasthenia Gravis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • RituximabDrug

    Intervention (rituximab): The treatment group will receive a total of two cycles of rituximab separated by 6 months. Each cycle is defined as one infusion (375mg/m2 IV) per week for four consecutive weeks

  • PlaceboDrug

    The placebo group will receive a vehicle control infusion

Study groups in NCT02110706
Study groupRoleWhat they receive
PlaceboPlacebo comparatorThe placebo group will receive a vehicle control infusion
Receives: Drug: Placebo
RituximabExperimentalIntervention (rituximab): The treatment group will receive a total of two cycles of rituximab separated by 6 months. Each cycle is defined as one infusion (375mg/m2 IV) per week for four consecutive weeks
Receives: Drug: Rituximab

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Steroid Sparing Effect

    Percent of subjects that achieve a ≥ 75% reduction in mean daily prednisone dose in the 4 weeks prior to week 52 and have clinical improvement or no significant worsening of symptoms (≤ 2 point increase in MGC score) as compared to 4-week period prior to randomization and initiation of treatment.

    Measured: 4 weeks prior baseline and 4 weeks prior to week 52

  2. Safety:Percentage of Study Participants With Treatment-related Adverse Experiences

    Evaluate treatment-Related Adverse Events (AEs) and Serious Adverse Events (SAEs)

    Measured: 52 weeks

Secondary outcomes (2)
  1. Change in Myasthenia Gravis Composite (MGC) Scores From Baseline to Week 52

    Evaluate whether there is a trend towards clinical benefit at end of 52 week treatment period, as measured by mean change in the MGC score, an MG-specific clinical outcomes scale used as endpoint in prior MG clinical trials. The Myasthenia Gravis Composite (MGC) scale consists of test items from the MG-ADL (Myasthenia Gravis Activities of Daily Living) scale and the QMG (Quantitative Myasthenia Gravis Scale) that measure symptoms and signs of MG, with weighted response options. The minimum score is 0, and the maximum score is 50. Higher scores correlate with clinical worsening of the disease.

    Measured: baseline and 52 weeks

  2. Change in Quantitative Myasthenia Gravis(QMG) Scores From Baseline to Week 52

    Evaluate whether there is a trend towards clinical benefit at end of 52 week treatment period, as measured by the mean change in the QMG score - a specific clinical outcome scale used as endpoint in prior MG clinical trials. The Quantitative Myasthenia Gravis Score (QMG) is a commonly used objective outcome measure in myasthenia gravis (MG) comprising 13 items, each with a possible score from 0 to 3, and a maximum possible of 39 points, where a higher score indicates more severe disease.

    Measured: baseline and 52 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted10 Apr 2014 (estimated)
  2. Study startMay 2014
  3. Primary completionJul 2017
  4. Study completionMay 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Single group
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
52 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02110706
Sponsor's protocol ID
1401013253-0
Other IDs
1U01NS084495-01A1, U01NS077179-01, U01NS077352
Status last verified
Mar 2020
First submitted
7 Apr 2014
Last updated
6 Mar 2020
Data monitoring committee
Yes

Publications

  • Roy B, Chen J, Khani-Habibabadi F, McLaren N, Soliven BC, Juel VC, O'Connor KC, Nowak RJ, Kusner LL, Kaminski HJ. A Distinct Immunological Signature in Late-Onset Myasthenia Gravis: Insights from an Exploratory Proteomics Study. Ann Neurol. 2026 Jan;99(1):198-210. doi: 10.1002/ana.78017. Epub 2025 Sep 6.

    PubMed 40913424
  • Nowak RJ, Coffey CS, Goldstein JM, Dimachkie MM, Benatar M, Kissel JT, Wolfe GI, Burns TM, Freimer ML, Nations S, Granit V, Smith AG, Richman DP, Ciafaloni E, Al-Lozi MT, Sams LA, Quan D, Ubogu E, Pearson B, Sharma A, Yankey JW, Uribe L, Shy M, Amato AA, Conwit R, O'Connor KC, Hafler DA, Cudkowicz ME, Barohn RJ; NeuroNEXT NN103 BeatMG Study Team. Phase 2 Trial of Rituximab in Acetylcholine Receptor Antibody-Positive Generalized Myasthenia Gravis: The BeatMG Study. Neurology. 2022 Jan 25;98(4):e376-e389. doi: 10.1212/WNL.0000000000013121.

    PubMed 34857535
  • Di Stefano V, Lupica A, Rispoli MG, Di Muzio A, Brighina F, Rodolico C. Rituximab in AChR subtype of myasthenia gravis: systematic review. J Neurol Neurosurg Psychiatry. 2020 Apr;91(4):392-395. doi: 10.1136/jnnp-2019-322606. Epub 2020 Feb 25.

    PubMed 32098874
  • Hehir MK, Hobson-Webb LD, Benatar M, Barnett C, Silvestri NJ, Howard JF Jr, Howard D, Visser A, Crum BA, Nowak R, Beekman R, Kumar A, Ruzhansky K, Chen IA, Pulley MT, LaBoy SM, Fellman MA, Greene SM, Pasnoor M, Burns TM. Rituximab as treatment for anti-MuSK myasthenia gravis: Multicenter blinded prospective review. Neurology. 2017 Sep 5;89(10):1069-1077. doi: 10.1212/WNL.0000000000004341. Epub 2017 Aug 11.

    PubMed 28801338

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Rituximab in people with Myasthenia Gravis, run by Yale University at 26 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 13 inclusion and 38 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 6 Mar 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 26 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 2 Oct 2018). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Steroid Sparing Effect (time frame: 4 weeks prior baseline and 4 weeks prior to week 52). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02110706, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Mar 2020.

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