title: Mycophenolate mofetil in AChR-antibody-positive myasthenia gravis: outcomes in 102 patients.
abstract: Two recent randomized, controlled trials failed to demonstrate a benefit of mycophenolate mofetil (MMF) over prednisone in the treatment of myasthenia gravis (MG). We reviewed our experience with MMF in MG to determine whether these trials may have been unsuccessful because of their short duration and the unpredicted benefit of prednisone. We reviewed outcomes and prednisone dosage for all our acetylcholine-receptor (AChR)-antibody positive MG patients treated with MMF alone or with prednisone for at least 3 months. The percentage of patients with a desirable outcome (MG-specific Manual Muscle Test score <4 or Myasthenia Gravis Foundation of America post-invention status of minimal manifestations or better) began to increase after 6 months; 80% of those followed for >24 months had a desirable outcome. Prednisone dose decreased after 12 months; after 25 months, 54.5% of patients took no prednisone and 75% took <7.5 mg/day. This retrospective analysis provides class IV evidence that MMF begins to improve AChR-positive MG after 6 months, both with prednisone and as monotherapy.
authors.affiliation: Department of Neurology, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Hehir
authors.forename: Ted M
authors.initials: TM
authors.lastname: Burns
authors.forename: Joshua
authors.initials: J
authors.lastname: Alpers
authors.forename: Mark R
authors.initials: MR
authors.lastname: Conaway
authors.forename: Michael
authors.initials: M
authors.lastname: Sawa
authors.forename: Donald B
authors.initials: DB
authors.lastname: Sanders
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D001323:Autoantibodies / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004357:Drug Synergism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D017063:Outcome Assessment, Health Care / Q000379:methods; D011241:Prednisone / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D011950:Receptors, Cholinergic / Q000276:immunology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D001323:Autoantibodies; D011950:Receptors, Cholinergic; D009173:Mycophenolic Acid; D011241:Prednisone