Early aggressive treatment strategy against myasthenia gravis.
OBJECTIVE
In treating myasthenia gravis (MG), our aims were to achieve early minimal manifestations (MM) by performing early aggressive therapy (EAT) using plasmapheresis and high-dose intravenous methylprednisolone, and then to maintain the status with low-dose oral corticosteroids (EAT strategy). We examined the merits of the EAT strategy.


METHODS
We retrospectively analyzed long-term effects of the EAT strategy (duration of therapy: 4.1 years) for 49 de novo MG patients and compared the effects to those of high-dose oral prednisolone therapy for 22 patients.


RESULTS
The EAT group achieved marked early improvement with much lower doses of oral prednisolone compared to the high-dose prednisolone group. The patients who achieved MM with prednisolone ≤5 mg/day were more frequent in the EAT group at both 1 year (57.1 vs. 4.5%) and final observation (77.6 vs. 27.3%). Both new-onset diabetes and patients who had complained of moon face were less frequent in the EAT group. However, in the EAT group, due to a temporary inability to maintain MM, additional short-term hospitalizations to return to MM by EAT were required.


CONCLUSIONS
The EAT strategy has advantages of early improvement with less frequent steroid-related complications. The labor and cost required are evident disadvantages.
Department of Neurology, Hanamaki General Hospital, 4-28 Kajoh-chou, Hanamaki, Japan.
Yuriko
Y
Nagane
Shigeaki
S
Suzuki
Norihiro
N
Suzuki
Kimiaki
K
Utsugisawa
D004305:Dose-Response Relationship, Drug; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008775:Methylprednisolone / Q000008:administration & dosage*; D009157:Myasthenia Gravis / Q000628:therapy*; D010956:Plasmapheresis; D011239:Prednisolone / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D011239:Prednisolone; D008775:Methylprednisolone