title: Benefits from sustained-release pyridostigmine bromide in myasthenia gravis: results of a prospective multicenter open-label trial.
abstract: BACKGROUND
  For more than 50 years the acetylcholinesterase inhibitor pyridostigmine bromide has been the drug of choice in the symptomatic therapy for myasthenia gravis. The sustained-release dosage form of pyridostigmine (SR-Pyr) is only available in a limited number of countries (e.g. in the United States and Germany). Astonishingly, the therapeutic usefulness of SR-Pyr has not yet been evaluated.
  
  
  METHODS
  In this non-interventional prospective open-label trial, 72 patients with stable myasthenia gravis were switched from instant-release dosage forms of pyridostigmine bromide to SR-Pyr. The results from the 37 patients younger than 60 years were separately analyzed.
  
  
  RESULTS
  The initial daily dose of SR-Pyr was 288.1 ± 171.0mg. The drug switch was unproblematic in all patients. The number of daily doses was significantly reduced from 4.3 to 3.6 (p=0.011). The switch to SR-Pyr ameliorated the total quantified myasthenia gravis (QMG) score from 0.9 ± 0.5 to 0.6 ± 0.4 (p<0.001) in all patients and in the younger subgroup. This was accompanied by a significant improvement in the quality of life parameters. The health status valued by EuroQoL questionnaire improved from 0.626 ± 0.286 to 0.782 ± 0.186 (p<0.001). After switching to SR-Pyr, 28 adverse reactions disappeared and 24 adverse reactions occurred less frequent or weaker, however, 17 new adverse reactions were documented.
  
  
  CONCLUSIONS
  Our results support the usefulness of SR-Pyr in an individualized therapeutic regimen to improve quality of life regardless of the patient's age in myasthenia gravis.
authors.affiliation: Department of Neurology, Geriatric Medicine and Palliative Care, General Hospital, Grosse Parower St, 18435 Stralsund, Germany. j.sieb@klinikum-hst.de
authors.forename: Jörn Peter
authors.initials: JP
authors.lastname: Sieb
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Köhler
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D003710:Demography; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000188:drug therapy*; D009460:Neurologic Examination; D011446:Prospective Studies; D011729:Pyridostigmine Bromide / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D011788:Quality of Life; D055815:Young Adult
chemical_list: D002800:Cholinesterase Inhibitors; D003692:Delayed-Action Preparations; D011729:Pyridostigmine Bromide