Ying Zhang1,2, Fujun Li3, Hongwen Zhu4, Hongmei Yu5, Tian Wang6, Xudong Yan7. 1. Department of Neurology, South China Hospital, Health Science Center, Shenzhen University, No.1 Fuxin Road, Longgang District, Shenzhen, 518116, China. 8631550@qq.com. 2. Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China. 8631550@qq.com. 3. Department of General Surgery, South China Hospital, Health Science Center, Shenzhen University, No.1 Fuxin Road, Longgang District, Shenzhen, 518116, China. 4. Department of Management Science and Engineering, School of Management, Harbin Institute of Technology, Harbin, Heilongjiang, China. 5. Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China. 6. Department of Rehabilitation, The Second Hospital of Harbin, Harbin, Heilongjiang, China. 7. Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an No.3 Hospital, Xi'an, Shaanxi, China.
Abstract
OBJECTIVE: We investigated the efficacy of low-dose prednisolone (PSL) regimen in patients with generalized myasthenia gravis (MG) post-thymectomy and its correlation with long-term outcome. METHODS: This is a 2-year observational study. The subjects were aged 16-75 years, a Myasthenia Gravis Foundation of America (MGFA) clinical classification of II to IV, generalized MG after thymectomy. We selected a low-dose (5 mg/day) initiation and slowly incrementing (10 mg every 4 weeks) PSL therapy regimen. We collected the clinical characteristics, treatment-related data, and 2-year clinical outcomes of MG patients, and analyzed the effect of various factors on the achievement of the treatment target. RESULTS: Sixty-three generalized MG were recruited in our study. After 2 years of observation, 52 patients (82.5%) of generalized MG achieved treatment goal. Based on the maximum daily dose of PSL received, the MG patients were divided into 20 mg, 30 mg, and ≥ 40 mg groups. Subgroup analysis showed that the 20 mg group had the highest rate of achieving the treatment target (94.9%), followed by the 30 mg group (73.3%) and the lowest rate was among the ≥ 40 mg group (44.4%). Using a multivariate logistic regression analysis, we identified that the maximum daily dose of PSL 20 mg was the only positive, independent predictor of treatment goal achievement after 2 years. CONCLUSION: Low-dose initiation, slowly incrementing PSL therapy is feasible for generalized MG patients after thymectomy. Early response to low-dose PSL therapy may predict better long-term outcomes.
OBJECTIVE: We investigated the efficacy of low-dose prednisolone (PSL) regimen in patients with generalized myasthenia gravis (MG) post-thymectomy and its correlation with long-term outcome. METHODS: This is a 2-year observational study. The subjects were aged 16-75 years, a Myasthenia Gravis Foundation of America (MGFA) clinical classification of II to IV, generalized MG after thymectomy. We selected a low-dose (5 mg/day) initiation and slowly incrementing (10 mg every 4 weeks) PSL therapy regimen. We collected the clinical characteristics, treatment-related data, and 2-year clinical outcomes of MG patients, and analyzed the effect of various factors on the achievement of the treatment target. RESULTS: Sixty-three generalized MG were recruited in our study. After 2 years of observation, 52 patients (82.5%) of generalized MG achieved treatment goal. Based on the maximum daily dose of PSL received, the MG patients were divided into 20 mg, 30 mg, and ≥ 40 mg groups. Subgroup analysis showed that the 20 mg group had the highest rate of achieving the treatment target (94.9%), followed by the 30 mg group (73.3%) and the lowest rate was among the ≥ 40 mg group (44.4%). Using a multivariate logistic regression analysis, we identified that the maximum daily dose of PSL 20 mg was the only positive, independent predictor of treatment goal achievement after 2 years. CONCLUSION: Low-dose initiation, slowly incrementing PSL therapy is feasible for generalized MG patients after thymectomy. Early response to low-dose PSL therapy may predict better long-term outcomes.
Authors: Gil I Wolfe; Henry J Kaminski; Inmaculada B Aban; Greg Minisman; Hui-Chien Kuo; Alexander Marx; Philipp Ströbel; Claudio Mazia; Joel Oger; J Gabriel Cea; Jeannine M Heckmann; Amelia Evoli; Wilfred Nix; Emma Ciafaloni; Giovanni Antonini; Rawiphan Witoonpanich; John O King; Said R Beydoun; Colin H Chalk; Alexandru C Barboi; Anthony A Amato; Aziz I Shaibani; Bashar Katirji; Bryan R F Lecky; Camilla Buckley; Angela Vincent; Elza Dias-Tosta; Hiroaki Yoshikawa; Márcia Waddington-Cruz; Michael T Pulley; Michael H Rivner; Anna Kostera-Pruszczyk; Robert M Pascuzzi; Carlayne E Jackson; Jan J G M Verschuuren; Janice M Massey; John T Kissel; Lineu C Werneck; Michael Benatar; Richard J Barohn; Rup Tandan; Tahseen Mozaffar; Nicholas J Silvestri; Robin Conwit; Joshua R Sonett; Alfred Jaretzki; John Newsom-Davis; Gary R Cutter Journal: Lancet Neurol Date: 2019-01-25 Impact factor: 44.182
Authors: A Jaretzki; R J Barohn; R M Ernstoff; H J Kaminski; J C Keesey; A S Penn; D B Sanders Journal: Neurology Date: 2000-07-12 Impact factor: 9.910
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Authors: Gil I Wolfe; Henry J Kaminski; Inmaculada B Aban; Greg Minisman; Hui-Chien Kuo; Alexander Marx; Philipp Ströbel; Claudio Mazia; Joel Oger; J Gabriel Cea; Jeannine M Heckmann; Amelia Evoli; Wilfred Nix; Emma Ciafaloni; Giovanni Antonini; Rawiphan Witoonpanich; John O King; Said R Beydoun; Colin H Chalk; Alexandru C Barboi; Anthony A Amato; Aziz I Shaibani; Bashar Katirji; Bryan R F Lecky; Camilla Buckley; Angela Vincent; Elza Dias-Tosta; Hiroaki Yoshikawa; Márcia Waddington-Cruz; Michael T Pulley; Michael H Rivner; Anna Kostera-Pruszczyk; Robert M Pascuzzi; Carlayne E Jackson; Guillermo S Garcia Ramos; Jan J G M Verschuuren; Janice M Massey; John T Kissel; Lineu C Werneck; Michael Benatar; Richard J Barohn; Rup Tandan; Tahseen Mozaffar; Robin Conwit; Joanne Odenkirchen; Joshua R Sonett; Alfred Jaretzki; John Newsom-Davis; Gary R Cutter Journal: N Engl J Med Date: 2016-08-11 Impact factor: 91.245
Authors: Donald B Sanders; Gil I Wolfe; Michael Benatar; Amelia Evoli; Nils E Gilhus; Isabel Illa; Nancy Kuntz; Janice M Massey; Arthur Melms; Hiroyuki Murai; Michael Nicolle; Jacqueline Palace; David P Richman; Jan Verschuuren; Pushpa Narayanaswami Journal: Neurology Date: 2016-06-29 Impact factor: 9.910