Long-term treatment of steroid-dependent myasthenia gravis patients with low-dose tacrolimus.
OBJECTIVE
To examine the long-term effects of tacrolimus in steroid-dependent myasthenia gravis (MG) patients.


METHODS
We administered tacrolimus at 3 mg/day to 10 generalized MG patients presented with clinical worsening by a reduction in dose of prednisolone. The effects of tacrolimus were assessed by using the MG activities of daily living (MG-ADL) profile and the post-intervention status criteria provided by the Myasthenia Gravis Foundation of America (PSC-MGFA).


RESULTS
Seven patients were able to use tacrolimus without serious adverse effects for 1.0-5.1 years (mean 3.1 years). Further, its administration improved myasthenic symptoms to the level of pharmacologic remission or minimal manifestations of PSC-MGFA in 5 patients and made it possible to discontinue prednisolone administration in 4 of those 5. However, despite improvements caused by tacrolimus, the reduction in dose of prednisolone caused worsening of symptoms in another 2 patients. In addition, blood trough levels of tacrolimus lower than the recommended range were effective to maintain long-term improvements in 2 patients.


CONCLUSIONS
Administration of tacrolimus induced long-term improvements and enabled replacement of prednisolone in patients with intractable steroid-dependent MG.
Nagaishi
Akiko
A
Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga. nagaishi@kanazawa-med.ac.jp
Yukitake
Motohiro
M
Kuroda
Yasuo
Y
D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000188:drug therapy*; D011239:Prednisolone / Q000627:therapeutic use*; D011379:Prognosis; D016559:Tacrolimus / Q000627:therapeutic use*
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011239:Prednisolone; D016559:Tacrolimus