High-dose immunosuppressive therapy in generalised myasthenia gravis--a 2-year follow-up study.
BACKGROUND
Immunosuppressive (IS) therapy is increasingly advocated in the treatment of myasthenia gravis (MG). This study assessed whether early 'high-dose' IS therapy in new patients with generalised MG (GMG) altered the outcome and reduced the morbidity of GMG.


METHODS
Patients with GMG were treated with 'high-dose' IS therapy (prednisone < or = 1 mg/kg, azathioprine 2-3 mg/kg) and followed up for 2 years. Prednisone and azathioprine were initiated on diagnosis. Outcome measures were compared with those of controls previously treated at our clinic with 'low-dose' IS therapy. The primary outcome measure was the number of patients in remission at 1 and 2 years. Secondary outcomes included the MG scores (MGS) after 1 and 2 years, as well as the number of plasma exchanges (P/E), hospital and intensive care unit (ICU) admissions required for decompensated MG.


RESULTS
At 1 and 2 years there were significant improvements in the MGS of patients treated with 'high-dose' IS therapy compared with those of controls; 50% of these patients were in remission after 2 years compared with less than 16% of controls. The number of hospital and ICU admissions had also dropped significantly in the first year of patients receiving 'high-dose' IS treatment.


CONCLUSIONS
Early 'high-dose' IS therapy using azathioprine and prednisone in GMG resulted in a significant increase in the number of patients in remission and reduced morbidity at 1 and 2 years.
Heckmann
J M
JM
Neurology Unit, Groote Schuur Hospital and University of Cape Town.
LeePan
E B
EB
Eastman
R W
RW
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D009157:Myasthenia Gravis / Q000145:classification / Q000188:drug therapy*; D011241:Prednisone / Q000627:therapeutic use*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D001379:Azathioprine; D011241:Prednisone