Using the agreed starting and stopping criteria, rituximab can be made available within NHS Wales for the fourth-line or later treatment of refractory myasthenia gravis in adults.

The rituximab product with the lowest acquisition cost should be chosen for newly initiated patients. 

The risks and benefits of the off-label use of rituximab for this indication should be clearly stated and discussed with the patient to allow informed consent.

Providers should consult the relevant guidelines on prescribing unlicensed medicines before any off-label medicines are prescribed. 

This advice will be reviewed after 12 months or earlier if new evidence becomes available.