Early, aggressive treatment better for controlling MG symptoms: Study

Marked response differences seen between patients given early, fast-acting treatment, other group

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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Early and aggressive treatments tend to lead to better control of myasthenia gravis (MG) symptoms, a recent study reports.

The study suggests MG patients given early treatment with high doses of the corticosteroid methylprednisolone directly into the bloodstream are more likely to have minimal disease manifestations.

“The data presented here will contribute to the development of therapeutic strategies for MG and may serve as a guide for clinicians,” the researchers wrote in the study, “Effectiveness of early cycles of fast-acting treatment in generalised myasthenia gravis,” which was published in the Journal of Neurology, Neurosurgery, & Psychiatry.

While there’s no cure for MG, there are several treatments available to manage it. These therapies work by decreasing immune activity, reducing the autoimmune attack that drives the disease. Corticosteroids, such as oral prednisone, are often a key part of treatment.

Treating MG has traditionally started with relatively low doses of corticosteroids, with the goal of controlling symptoms without causing substantial side effects. Many patients on these regimens have symptom worsening, however, suggesting they may benefit from more aggressive early therapies.

Scientists in Japan analyzed data from 1,066 people with generalized MG who enrolled in the Japan MG Registry Study Group.

Among them, 484 (45.4%) were given early, fast-acting treatment (EFT) within six months of starting to trigger a state of minimal disease manifestations early in the disease course. For the purposes of this study, EFT was defined as plasmapheresis (plasma exchange), intravenous immunoglobulin (IVIG) therapy, and/or intravenous high-dose methylprednisolone (IVMP), a more potent corticosteroid than oral prednisone. EFT is typically combined with other standard therapies like low-dose oral prednisone.

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Better results with aggressive treatment

There were marked differences between the EFT and non-EFT groups. Those given EFT were significantly older at the onset of their disease and tended to have significantly worse symptom severity scores.

During the follow-up, the proportion of patients with minimal disease manifestations was significantly higher in the EFT group than the non-EFT group (74.3% vs. 58.9%). The proportion of patients with minimal manifestations on less than 5 mg of prednisone was also higher in the EFT group (62% vs. 47.1%).

This finding “supports that EFT could increase the possibility of achieving the [minimal disease manifestations] in patients with MG,” the researchers wrote.

The time to achieve minimal disease manifestations was on average significantly shorter with the EFT group than the non-EFT group, statistical analyses showed. Similar results were seen across all disease subtypes.

“We demonstrate that EFT significantly affects the achievement of [minimal disease manifestations], regardless of clinical MG subgroup,” the researchers wrote.

Within the EFT group, 248 patients received IVMP, while 102 received other forms of EFT. The likelihood of achieving minimal disease manifestations was significantly increased — by about 57% — for those on IVMP compared with non-IVMP regimens, statistical analyses showed.

“Among EFT treatments, IVMP seems to be efficacious for achieving the treatment target by early suppression of disease activity,” the researchers wrote, noting their study was limited by its retrospective design, as well as by underlying differences between groups that can’t be perfectly controlled in statistical analyses.

EFT also has drawbacks, even though it may be more effective for relieving symptoms, the researchers acknowledged. These include the high cost and need for in-hospital treatment. Efforts should be made to identify which patients might benefit the most from early and aggressive treatment strategies, they said.