title: Induction intravenous cyclophosphamide followed by maintenance oral immunosuppression in refractory myasthenia gravis.
abstract: BACKGROUND
  Myasthenia gravis (MG) can be refractory to conventional immunotherapy. We report on the efficacy and durability of intravenous (IV) remission-induction cyclophosphamide (CYC) followed by oral immunosuppression in refractory MG.
  
  
  METHODS
  We identified 8 patients from our medical records with moderate or severe refractory MG who were treated with 6 cycles of IV CYC (0.75 g/m(2) ) every 4 weeks followed by oral immunosuppression.
  
  
  RESULTS
  Six patients improved within 3 months of treatment. Four patients remained in clinical remission (mean follow-up 31 months). Two patients responded partially, and 1 patient relapsed after 11 months. Two patients were non-responders. CYC was well tolerated. Acetylcholine receptor antibody levels remained below pretreatment levels in patients in clinical remission. The leukocyte nadir was lower in CYC responders.
  
  
  CONCLUSIONS
  Remission-induction IV CYC followed by oral immunosuppression is a rapid, effective, and durable treatment for refractory MG. Adding a post-CYC immunosuppressant may account for low relapse rates compared with other published series.
authors.affiliation: Department of Neurology, Concord Repatriation General Hospital, Concord West, New South Wales, 2139, Australia.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Buzzard
authors.affiliation: Department of Immunology, Concord Repatriation General Hospital, Concord West, New South Wales, Australia.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Meyer
authors.affiliation: Department of Neurology, Concord Repatriation General Hospital, Concord West, New South Wales, 2139, Australia.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Hardy
authors.affiliation: Department of Immunology, Concord Repatriation General Hospital, Concord West, New South Wales, Australia.
authors.forename: D Sean
authors.initials: DS
authors.lastname: Riminton
authors.affiliation: Department of Neurology, Concord Repatriation General Hospital, Concord West, New South Wales, 2139, Australia.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Reddel
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D003520:Cyclophosphamide / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology*; D020551:Pulse Therapy, Drug / Q000379:methods; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide
keywords: cyclophosphamide; immunosuppression; myasthenia gravis; refractory; treatment