Satisfactory Response With Achieving Maintenance Low-Dose Prednisone in Generalized Myasthenia Gravis

Abuzinadah, Ahmad R.; Jabari, Duaa; Jawdat, Omar; Pasnoor, Mamatha; Glenn, Melanie; Herbelin, Laura; McVey, April; Barohn, Richard J.; Dimachkie, Mazen M.

doi:10.1097/cnd.0000000000000219

Cited by 7 publications

(9 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Beghi et al [13] found that mild clinical disability at MG onset was associated with higher odds of achieving remission (2.37 [95% CI 1.53–3.67]) than those with severe disability. This finding is also supported by our previously published data and by another group of researchers [3, 15]. Second, prednisone dosage reduction predicted a higher risk of future exacerbations than the “no-reduction” group.…”

Section: Discussionsupporting

confidence: 89%

“…The Human Subjects Committee at the University of Kansas Medical Center reviewed the protocol and determined it to be exempt. The inclusion criteria [3] were (1) AChR antibody-positive MG, (2) generalized weakness, and (3) patients must have been assessed by a neurologist within 3 years from symptom onset. We excluded patients with (1) other causes of weakness such as myopathy, neuropathy, or multiple sclerosis and (2) muscle-specific kinase antibodies (Anti-MuSK).…”

Section: Methodsmentioning

confidence: 99%

“…The overall treatment paradigm for MG at our center was consistent with International Consensus Guidance for the Management of Myasthenia Gravis where patient started on daily prednisone with a dose range from 40 to 60 mg. Prednisone dose is tapered after achieving remission or minimal manifestation status. SSI is added if a relapse occurred during steroid taper or minimal manifestation status was not achieved [3, 4].…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Exacerbation Rate in Generalized Myasthenia Gravis and Its Predictors

et al. 2020

Self Cite

View full text Add to dashboard Cite

Objective: The aim of the study was to estimate the exacerbation incidence rate (IR) in acetylcholine receptor antibody (AChR)-positive generalized myasthenia gravis (MG) and its predictors. Methods: The primary outcome in this retrospective study was to estimate moderate-to-severe (M-S) exacerbations IR in the early course of generalized MG. The secondary outcome was to explore the predictors of MG exacerbations. Results: Between 1999 and 2015, we identified 78 AChR-positive generalized MG patients and 37 M-S exacerbations over the first 6 years following the onset of generalized MG symptoms. The M-S exacerbation IR was 12.2 per 100 person years (95% confidence interval [CI] 8.8–16.8). Any exacerbation (including mild) IR was 24.4 per 100 person years (95% CI 19.4–30.7). After controlling for confounding factors, MG exacerbation IR predictors included gender, disease severity at onset, and prednisone dose reduction with risk ratio of 0.34 (male gender), 2.67, and 20.8, respectively (all p values <0.05). M-S exacerbation occurred in 25 cases (32.1%), while any exacerbation (mild or M-S) was detected in 45 cases (57.7%). Conclusion: More than half of newly diagnosed AChR + MG cases experience an exacerbation in the first 6 years. Gender, disease severity at onset and prednisone dose reduction are predictors that could inform clinical practice and future research.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Exacerbation Rate in Generalized Myasthenia Gravis and Its Predictors

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Some patients refuse to be started on steroids because of concerns of side effects and in these circumstances adding a steroid-sparing immunosuppressant at diagnosis is a viable option. A retrospective study by Abuzinadah et al ( 23 ), showed that a satisfactory response (which included CSR, PR, and MM) was achieved in about 50% of MG patients with generalized disease when they were maintained on low dose prednisolone, without a steroid-sparing immunosuppressant with follow-up extending up to 6 years.…”

Section: Immunomodulatory Therapies For Generalized Mgmentioning

confidence: 99%

A Practical Approach to Managing Patients With Myasthenia Gravis—Opinions and a Review of the Literature

Farrugia

Goodfellow

2020

Front. Neurol.

View full text Add to dashboard Cite

When the diagnosis of myasthenia gravis (MG) has been secured, the aim of management should be prompt symptom control and the induction of remission or minimal manifestations. Symptom control, with acetylcholinesterase inhibitors such as pyridostigmine, is commonly employed. This may be sufficient in mild disease. There is no single universally accepted treatment regimen. Corticosteroids are the mainstay of immunosuppressive treatment in patients with more than mild MG to induce remission. Immunosuppressive therapies, such as azathioprine are prescribed in addition to but sometimes instead of corticosteroids when background comorbidities preclude or restrict the use of steroids. Rituximab has a role in refractory MG, while plasmapheresis and immunoglobulin therapy are commonly prescribed to treat MG crisis and in some cases of refractory MG. Data from the MGTX trial showed clear evidence that thymectomy is beneficial in patients with acetylcholine receptor (AChR) antibody positive generalized MG, up to the age of 65 years. Minimally invasive thymectomy surgery including robotic-assisted thymectomy surgery has further revolutionized thymectomy and the management of MG. Ocular MG is not life-threatening but can be significantly disabling when diplopia is persistent. There is evidence to support early treatment with corticosteroids when ocular motility is abnormal and fails to respond to symptomatic treatment. Treatment needs to be individualized in the older age-group depending on specific comorbidities. In the younger age-groups, particularly in women, consideration must be given to the potential teratogenicity of certain therapies. Novel therapies are being developed and trialed, including ones that inhibit complement-induced immunological pathways or interfere with antibody-recycling pathways. Fatigue is common in MG and should be duly identified from fatigable weakness and managed with a combination of physical therapy with or without psychological support. MG patients may also develop dysfunctional breathing and the necessary respiratory physiotherapy techniques need to be implemented to alleviate the patient's symptoms of dyspnoea. In this review, we discuss various facets of myasthenia management in adults with ocular Farrugia and Goodfellow Practical Approaches to Myasthenia Management and generalized disease, including some practical approaches and our personal opinions based on our experience.

show abstract

“…However, a recently published work showed maximum severity during the first year was not a predictor of the satisfactory response (remission/MMS while on low-dose prednisone without PE or IVIG). 37 A previous study (including 268 cases) also found that prognosis is favorable for the majority of MG patients regardless of maximum disease severity. 4 We speculated this inconsistency may be explained by the maximum severity (such as QMG score or MGFA classification) usually obtained during exacerbation.…”

Section: Discussionmentioning

confidence: 84%

Factors affecting minimal manifestation status induction in myasthenia gravis

Yang

Dong

et al. 2022

Ther Adv Neurol Disord

View full text Add to dashboard Cite

Background: Minimal manifestation status (MMS) is an important landmark in the treatment of myasthenia gravis (MG), and predictors of MMS induction have rarely been identified in previous studies. Objective: The objective of this study is to evaluate the clinical factors associated with MMS induction among patients with MG. Design: This two-step retrospective cohort study with a single center investigated the factors that may be associated with MMS induction and retested these predictors in a test cohort. Methods: A total of 388 diagnosed MG patients who visited Xiangya Hospital between 1 July 2015 and 1 July 2019 were involved. We performed detailed chart reviews and recorded all cases achieving MMS. Demographics and clinical characteristics were also collected and their relationships to achieving MMS were investigated. Results: MMS was achieved in 124 patients (50.2%), and the median time to achieve MMS was 26 months. Several factors were found to be associated with MMS induction in exploring cohort, including muscle-specific tyrosine-protein kinase receptor (MuSK) antibody positivity (adjusted hazard ratio, HR = 4.333, 95% confidence interval, CI: 1.862–10.082), isolated ocular involvement (adjusted HR = 1.95, 95% CI: 1.284–2.961), and low baseline quantitative myasthenia gravis score (QMG score; adjusted HR = 2.022, 95% CI: 1.086–3.764). These factors were then retested in the test cohort. Isolated ocular involvement or low baseline QMG scores were factors found to be beneficial for MMS induction were confirmed. Conclusion: Isolated ocular involvement and low baseline QMG score are predictors of MMS induction in MG patients.

show abstract

Satisfactory Response With Achieving Maintenance Low-Dose Prednisone in Generalized Myasthenia Gravis

Cited by 7 publications

References 23 publications

Exacerbation Rate in Generalized Myasthenia Gravis and Its Predictors

Exacerbation Rate in Generalized Myasthenia Gravis and Its Predictors

A Practical Approach to Managing Patients With Myasthenia Gravis—Opinions and a Review of the Literature

Factors affecting minimal manifestation status induction in myasthenia gravis

Contact Info

Product

Resources

About