Long-term effects of combined immunosuppressive treatment on myasthenic crisis.
OBJECTIVE
We studied the long-term crisis-preventing effect of combined prednisolone-azathioprine (PR-AZA) treatment in myasthenia gravis (MG).


METHODS
Case-control study with a median follow-up of 64 months in the treated group, and 80 months in the non-treated group. Sixty-nine patients with episodes of myasthenic crisis (MC) were treated and followed prospectively in 1990-2004. Twenty-seven patients had MC between 1990 and 1996, and were not treated with immunosuppressants on long-term. Long-term PR-AZA treatment was introduced in another 42 patients, who developed MC in 1997-2004. The difference in the frequency of repeated MCs between the treated and the non-treated group during long-term follow-up was investigated. As secondary end-points, we analyzed the number of admittances to the ICU; the number of mechanical ventilation episodes; the duration of ICU treatment; the characteristics of the applied treatment; and the functional outcome of the patients 1 month after the onset of the crisis.


RESULTS
Recurrent MCs occurred in 74% of the non-treated and 19% of the treated group (P < 0.001). The number of ICU admissions (P = 0.005) and mechanical ventilation events (P = 0.002) were also reduced. The highly significant MC preventing effect of PR-AZA was evident after 6 months.


CONCLUSIONS
After the initial 6 months of therapy, PR-AZA is effective in preventing MC.
Rózsa
C
C
Jahn Ferenc Teaching Hospital, Budapest, Hungary.
Mikor
A
A
Kasa
K
K
Illes
Z
Z
Komoly
S
S
D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000627:therapeutic use*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002986:Clinical Trials as Topic; 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*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011239:Prednisolone; D001379:Azathioprine