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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...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group UK
2020
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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. |
format | Online Article Text |
id | pubmed-7421901 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
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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