Using the agreed starting and stopping criteria, rituximab can be made available within NHS Wales:

• as a first-line add-on treatment for generalised myasthenia gravis in adults;
• as a fourth-line or later treatment option for refractory generalised myasthenia gravis in adults.

Rituximab should be prescribed on the basis of lowest acquisition cost.

The risks and benefits of the off-label use of rituximab for these indications 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.