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Intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis

Corticosteroids may produce a paradoxical worsening of myasthenia gravis (MG) symptoms within the first weeks of treatment. We therefore wanted to assess the hypothesis that a prior infusion of intravenous immunoglobulin (IVIG) may have a protective effect. Our primary objectives were to show that t...

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Autores principales: Díez-Porras, Laura, Homedes, Christian, Alberti, Maria Antonia, Vélez-Santamaría, Valentina, Casasnovas, Carlos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7421901/
https://www.ncbi.nlm.nih.gov/pubmed/32782330
http://dx.doi.org/10.1038/s41598-020-70539-4
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author Díez-Porras, Laura
Homedes, Christian
Alberti, Maria Antonia
Vélez-Santamaría, Valentina
Casasnovas, Carlos
author_facet Díez-Porras, Laura
Homedes, Christian
Alberti, Maria Antonia
Vélez-Santamaría, Valentina
Casasnovas, Carlos
author_sort Díez-Porras, Laura
collection PubMed
description Corticosteroids may produce a paradoxical worsening of myasthenia gravis (MG) symptoms within the first weeks of treatment. We therefore wanted to assess the hypothesis that a prior infusion of intravenous immunoglobulin (IVIG) may have a protective effect. Our primary objectives were to show that the coadministration of immunoglobulins and glucocorticoids is safe and effective for controlling myasthenic symptoms, and to compare the exacerbation rate with this approach and historical practice without IVIG. We recruited 45 patients with generalized MG who required corticosteroids for the first time and we gave all IVIG before starting the full doses of prednisone. Monitoring was performed with validated scales, questionnaires, and blood tests over a 6-week period. Only 4.4% had severe adverse effects related to IVIG and 86.7% improved clinically. Notably, only 2.2% had a paradoxical symptom exacerbation in the first weeks of starting prednisone, which was statistically lower than the 42% reported in a historical series. We conclude that adjuvant therapy with IVIG when starting prednisone for the first time in patients with generalized MG is safe and effective. Given that the rate of paradoxical worsening was lower than that previously reported, the addition of IVIG may have a protective effect against such exacerbations.
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spelling pubmed-74219012020-08-13 Intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis Díez-Porras, Laura Homedes, Christian Alberti, Maria Antonia Vélez-Santamaría, Valentina Casasnovas, Carlos Sci Rep Article Corticosteroids may produce a paradoxical worsening of myasthenia gravis (MG) symptoms within the first weeks of treatment. We therefore wanted to assess the hypothesis that a prior infusion of intravenous immunoglobulin (IVIG) may have a protective effect. Our primary objectives were to show that the coadministration of immunoglobulins and glucocorticoids is safe and effective for controlling myasthenic symptoms, and to compare the exacerbation rate with this approach and historical practice without IVIG. We recruited 45 patients with generalized MG who required corticosteroids for the first time and we gave all IVIG before starting the full doses of prednisone. Monitoring was performed with validated scales, questionnaires, and blood tests over a 6-week period. Only 4.4% had severe adverse effects related to IVIG and 86.7% improved clinically. Notably, only 2.2% had a paradoxical symptom exacerbation in the first weeks of starting prednisone, which was statistically lower than the 42% reported in a historical series. We conclude that adjuvant therapy with IVIG when starting prednisone for the first time in patients with generalized MG is safe and effective. Given that the rate of paradoxical worsening was lower than that previously reported, the addition of IVIG may have a protective effect against such exacerbations. Nature Publishing Group UK 2020-08-11 /pmc/articles/PMC7421901/ /pubmed/32782330 http://dx.doi.org/10.1038/s41598-020-70539-4 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Article
Díez-Porras, Laura
Homedes, Christian
Alberti, Maria Antonia
Vélez-Santamaría, Valentina
Casasnovas, Carlos
Intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis
title Intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis
title_full Intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis
title_fullStr Intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis
title_full_unstemmed Intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis
title_short Intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis
title_sort intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7421901/
https://www.ncbi.nlm.nih.gov/pubmed/32782330
http://dx.doi.org/10.1038/s41598-020-70539-4
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