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Reappraisal of Oral Steroid Therapy for Myasthenia Gravis

Treatment with oral corticosteroids at high doses with an escalation and de-escalation schedule is effective against myasthena gravis (MG). In fact, the use of corticosteroids has led to a reduction in mortality to below 10% after the 1960s. However, long-term use of oral steroids above a certain do...

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Autores principales: Imai, Tomihiro, Suzuki, Shigeaki, Nagane, Yuriko, Uzawa, Akiyuki, Murai, Hiroyuki, Utsugisawa, Kimiaki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7477376/
https://www.ncbi.nlm.nih.gov/pubmed/32982912
http://dx.doi.org/10.3389/fneur.2020.00868
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author Imai, Tomihiro
Suzuki, Shigeaki
Nagane, Yuriko
Uzawa, Akiyuki
Murai, Hiroyuki
Utsugisawa, Kimiaki
author_facet Imai, Tomihiro
Suzuki, Shigeaki
Nagane, Yuriko
Uzawa, Akiyuki
Murai, Hiroyuki
Utsugisawa, Kimiaki
author_sort Imai, Tomihiro
collection PubMed
description Treatment with oral corticosteroids at high doses with an escalation and de-escalation schedule is effective against myasthena gravis (MG). In fact, the use of corticosteroids has led to a reduction in mortality to below 10% after the 1960s. However, long-term use of oral steroids above a certain dosage level is known to cause a number of problems. In 2014, the Japanese clinical guidelines for MG proposed that the first goal in MG treatment (treatment target) should be set at minimal manifestations (MM) with oral prednisolone (PSL) 5 mg/day or below, and that treatment strategies should strive to attain this level as rapidly as possible. In 2015, a multicenter, cross-sectional study revealed that higher PSL dose and longer PSL treatment do not ensure better outcome. In the absence of good response, the PSL dose should be decreased by combining with modalities such as plasma exchange/plasmapheresis and intravenous immunoglobulin (fast-acting treatments). In 2018, we conducted a multicenter, cross-sectional study in a large population of Japanese patients with generalized MG, aiming to elucidate the correlation between oral PSL regimens and achievement of treatment goals. The ORs for low vs. high dose to achieve treatment goals at 1, 2, and 3 years were 10.4, 2.75, and 1.86, respectively, whereas the corresponding ORs for low vs. medium dose were 13.4, 3.99, and 4.92. Early combination with fast-acting therapy (OR 2.19 at 2 years, 2.11 at 3 years) or combination with calcineurin inhibitors (OR 2.09 at 2 years, 2.36 at 3 years) were also positively associated with achieving treatment goals. These results indicate that early combination of low-dose PSL regimens with other therapies is the key for early achievement of treatment goals in generalized MG. However, even with this regimen, ~35% of patients did not achieve the treatment target after 3 years. These results suggest the limitation of the current oral corticosteroid therapy. We need to develop new treatment options to increase the rate of satisfactory outcome.
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spelling pubmed-74773762020-09-26 Reappraisal of Oral Steroid Therapy for Myasthenia Gravis Imai, Tomihiro Suzuki, Shigeaki Nagane, Yuriko Uzawa, Akiyuki Murai, Hiroyuki Utsugisawa, Kimiaki Front Neurol Neurology Treatment with oral corticosteroids at high doses with an escalation and de-escalation schedule is effective against myasthena gravis (MG). In fact, the use of corticosteroids has led to a reduction in mortality to below 10% after the 1960s. However, long-term use of oral steroids above a certain dosage level is known to cause a number of problems. In 2014, the Japanese clinical guidelines for MG proposed that the first goal in MG treatment (treatment target) should be set at minimal manifestations (MM) with oral prednisolone (PSL) 5 mg/day or below, and that treatment strategies should strive to attain this level as rapidly as possible. In 2015, a multicenter, cross-sectional study revealed that higher PSL dose and longer PSL treatment do not ensure better outcome. In the absence of good response, the PSL dose should be decreased by combining with modalities such as plasma exchange/plasmapheresis and intravenous immunoglobulin (fast-acting treatments). In 2018, we conducted a multicenter, cross-sectional study in a large population of Japanese patients with generalized MG, aiming to elucidate the correlation between oral PSL regimens and achievement of treatment goals. The ORs for low vs. high dose to achieve treatment goals at 1, 2, and 3 years were 10.4, 2.75, and 1.86, respectively, whereas the corresponding ORs for low vs. medium dose were 13.4, 3.99, and 4.92. Early combination with fast-acting therapy (OR 2.19 at 2 years, 2.11 at 3 years) or combination with calcineurin inhibitors (OR 2.09 at 2 years, 2.36 at 3 years) were also positively associated with achieving treatment goals. These results indicate that early combination of low-dose PSL regimens with other therapies is the key for early achievement of treatment goals in generalized MG. However, even with this regimen, ~35% of patients did not achieve the treatment target after 3 years. These results suggest the limitation of the current oral corticosteroid therapy. We need to develop new treatment options to increase the rate of satisfactory outcome. Frontiers Media S.A. 2020-08-25 /pmc/articles/PMC7477376/ /pubmed/32982912 http://dx.doi.org/10.3389/fneur.2020.00868 Text en Copyright © 2020 Imai, Suzuki, Nagane, Uzawa, Murai and Utsugisawa. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Imai, Tomihiro
Suzuki, Shigeaki
Nagane, Yuriko
Uzawa, Akiyuki
Murai, Hiroyuki
Utsugisawa, Kimiaki
Reappraisal of Oral Steroid Therapy for Myasthenia Gravis
title Reappraisal of Oral Steroid Therapy for Myasthenia Gravis
title_full Reappraisal of Oral Steroid Therapy for Myasthenia Gravis
title_fullStr Reappraisal of Oral Steroid Therapy for Myasthenia Gravis
title_full_unstemmed Reappraisal of Oral Steroid Therapy for Myasthenia Gravis
title_short Reappraisal of Oral Steroid Therapy for Myasthenia Gravis
title_sort reappraisal of oral steroid therapy for myasthenia gravis
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7477376/
https://www.ncbi.nlm.nih.gov/pubmed/32982912
http://dx.doi.org/10.3389/fneur.2020.00868
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