Treatment of myasthenia gravis with adrenocorticotropic hormone (ACTH): massive short-term and maintenance treatment.

History of outcome measures for myasthenia gravis

“…In the middle of the 20th century the initial use of ACTH followed by the gradual widespread use of corticosteroids improved both the “quantity of life” and quality of life for MG patients 3, 7–27. Torda and Wolff's 1949 report,7 for example, which demonstrated efficacy of intramuscular injections of ACTH, included these descriptions: “On the second or third day after the last injection of the adrenocorticotropic hormone the situation changed: the patients exhibited and described increasing well‐being and began to reduce the daily intake of neostigmine bromide and other agents … there was clearly evident improvement of the facial muscle strength, the general muscle weakness and easy fatigability diminished, and the ptosis of the eye‐lids was less evident.…”

Treatment of ocular myasthenia with corticotrophin

“…Our patients were given corticotrophin for much longer than in most of the published reports and this probably explains why their improvement was maintained for such long periods. We would support the suggestion of Cape and Utterback (1969) that maintenance therapy should be tried for those patients who improve on corticotrophin but relapse when it is stopped.…”

“…In some the improvement continued for period of weeks or months gradually reverted to its previous level. Cape and Utterback (1969) treated five patients with about 1,000 u. corticotrophin over 10 days. In three patients there was deterioration within the first week.…”

“…In generalized myasthenia courses of corticotrophin for five to 10 days have been noted to produce a deterioration followed by improvement which may persist for several months (Freydberg, 1960;Grob and Namba, 1966;Osserman and Genkins, 1966;Reis, Liljestrand, and Matell, 1966). Recently, Cape and Utterback (1969) have suggested that maintenance injections weekly or twice monthly may prolong the remission. In the only report on the treatment of ocular myasthenia by Mount (1964a and b), no significant improvement was detected after an eight day course of corticotrophin.…”

Clinical significance of immunopathological mechanisms in diseases of the nervous system

“…(d) Myasthenia gravis. ACTH given in brief massive dosage to patients with myasthenia may be followed by a short-lived remission, but while the drug is being given the disease is frequently much worse (see Strauss, 1968;Cape & Utterback, 1969). Whether the improvement following the administration of ACTH is due to an immunosuppressive effect or some other action is not known.…”