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Less is not necessarily more: low-dose corticosteroid therapy and long-term prognosis in generalized myasthenia gravis after thymectomy

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Abstract

Objective

We investigated the efficacy of low-dose prednisolone (PSL) regimen in patients with generalized myasthenia gravis (MG) post-thymectomy and its correlation with long-term outcome.

Methods

This is a 2-year observational study. The subjects were aged 16–75 years, a Myasthenia Gravis Foundation of America (MGFA) clinical classification of II to IV, generalized MG after thymectomy. We selected a low-dose (5 mg/day) initiation and slowly incrementing (10 mg every 4 weeks) PSL therapy regimen. We collected the clinical characteristics, treatment-related data, and 2-year clinical outcomes of MG patients, and analyzed the effect of various factors on the achievement of the treatment target.

Results

Sixty-three generalized MG were recruited in our study. After 2 years of observation, 52 patients (82.5%) of generalized MG achieved treatment goal. Based on the maximum daily dose of PSL received, the MG patients were divided into 20 mg, 30 mg, and ≥ 40 mg groups. Subgroup analysis showed that the 20 mg group had the highest rate of achieving the treatment target (94.9%), followed by the 30 mg group (73.3%) and the lowest rate was among the ≥ 40 mg group (44.4%). Using a multivariate logistic regression analysis, we identified that the maximum daily dose of PSL 20 mg was the only positive, independent predictor of treatment goal achievement after 2 years.

Conclusion

Low-dose initiation, slowly incrementing PSL therapy is feasible for generalized MG patients after thymectomy. Early response to low-dose PSL therapy may predict better long-term outcomes.

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Abbreviations

AChR Ab:

Acetylcholine receptor antibody

AAN:

American Academy Neurology

CSR:

Complete stable remission

MMS:

Minimal manifestation status

MG:

Myasthenia gravis

MGFA:

Myasthenia Gravis Foundation of America

PR:

Pharmacologic remission

PIS:

Post-intervention status

PSL:

Prednisolone

QMG:

Quantitative myasthenia gravis

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Acknowledgements

We thank all the staff involved in this study, as well as the patients and their families for their participation and cooperation. This work was supported by the Heilongjiang Provincial Postdoctoral Science Foundation (LBH-Z16149) and the Scientific Research Fund of the Second Affiliated Hospital of Harbin Medical University (KYCX2018-18).

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Correspondence to Ying Zhang.

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The study was approved by the Ethics Committee of the 2nd affiliated hospital of Harbin Medical University.

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Zhang, Y., Li, F., Zhu, H. et al. Less is not necessarily more: low-dose corticosteroid therapy and long-term prognosis in generalized myasthenia gravis after thymectomy. Neurol Sci 43, 3949–3956 (2022). https://doi.org/10.1007/s10072-022-05897-0

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