Researchers found that a low-dose regimen of oral corticosteroids is better than high- or intermediate-dose regimens in maintaining treatment goals for patients with myasthenia gravis (MG).
The study “Oral corticosteroid dosing regimen and long-term prognosis in generalised myasthenia gravis: a multicentre cross-sectional study in Japan” was published in the Journal of Neurology, Neurosurgery and Psychiatry.
The most common agents used for MG management are oral corticosteroids, which traditionally have been used at high doses. However, there is no internationally accepted standard protocol for the use of oral corticosteroids, which may result in poor quality of life (QOL) for patients. This recent study investigated the correlation between the dose of oral prednisolone (PSL) and treatment outcomes.
The study involved 590 MG patients from 13 neurological centers in Japan. Patients were classified into one of three groups based on the dose of PSL: a high-dose group (237 patients), an intermediate-dose group (187 patients) and a low-dose group (166 patients). Patients were followed for three years of treatment.
Disease duration was significantly longer in the high-dose group, which also had a significantly higher percentage of patients with maximum severity. There were significantly more patients achieving the so-called minimal manifestation (MM) status or better (a suggested target in the treatment of MG) in the low-dose group compared to the other two groups during the three years.
Although there were other variables tested in the study, statistical analyses showed that the low-dose protocol was the “sole independent positive predictor to achieve” MM-or-better for more than six months after one year of treatment. The use of calcineurin inhibitors (CNIs) was another positive predictor for reaching treatment targets, irrespective of PSL dose.
Furthermore, the study suggests that a low-dose regimen can “suppress symptom aggravation through the entire course of the disease.”
The authors state that their study addresses the serious concern that current consensus guidance for MG management still leaves patients asking “How long should I take steroids, and at what doses?”
Despite the limitations of the study because of its retrospective nature and lack of blinded design, as well as the fact that the researchers did not compare the cost differences between the dosing regimens, the authors conclude they “expect that most patients would prefer low-dose PSL with early combination of other modalities to achieve the treatment target earlier, possibly with little symptom aggravation and less adverse effects, even if the cost is higher than high-dose PSL with an escalation and de-escalation schedule.”
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