High-dose immunosuppressive therapy in generalised myasthenia gravis--a 2-year follow-up study

Immunosuppressive (IS) therapy is increasingly advocated in the treatment of myasthenia gravis (MG). This study assessed whether early 'high-dose' IS therapy in new patients with generalised MG (GMG) altered the outcome and reduced the morbidity of GMG.

Patients with GMG were treated with 'high-dose' IS therapy (prednisone < or = 1 mg/kg, azathioprine 2-3 mg/kg) and followed up for 2 years. Prednisone and azathioprine were initiated on diagnosis. Outcome measures were compared with those of controls previously treated at our clinic with 'low-dose' IS therapy. The primary outcome measure was the number of patients in remission at 1 and 2 years. Secondary outcomes included the MG scores (MGS) after 1 and 2 years, as well as the number of plasma exchanges (P/E), hospital and intensive care unit (ICU) admissions required for decompensated MG.

At 1 and 2 years there were significant improvements in the MGS of patients treated with 'high-dose' IS therapy compared with those of controls; 50% of these patients were in remission after 2 years compared with less than 16% of controls. The number of hospital and ICU admissions had also dropped significantly in the first year of patients receiving 'high-dose' IS treatment.

Early 'high-dose' IS therapy using azathioprine and prednisone in GMG resulted in a significant increase in the number of patients in remission and reduced morbidity at 1 and 2 years.