Myasthenia gravis treated with ciclosporin

Six patients (4 females, 2 males) with generalized myasthenia gravis (MG) have been treated in an open study with ciclosporin (5-10 mg/kg/day), originally for 28 weeks. The age of the patients ranged from 16-61 years and the duration of symptoms from 5-30 years. Four of the patients had been thymectomized. Ciclosporin was added to prednisolone in 5 of the patients. Three of these had in addition previously used azathioprine without satisfactory improvement. The efficacy was measured by scoring the degree of muscle weakness on clinical examination and by scoring of the patients' personal assessment of their fatigability and muscle strength. In 5 patients there was a moderate to marked improvement in muscle strength and fatigueability on ciclosporin therapy. In one patient the effect was slight to moderate. The degree of improvement was similar in the one patient who received ciclosporin alone and in those also using prednisolone. The levels of anti ACh-r antibodies decreased in 3 patients, increased in 2, and were unchanged in one patient. Side effects known to occur on ciclosporin therapy were noticed, but they were tolerable in all patients. An increase in serum creatinine (mean 10%) and decrease in creatinine clearance (mean 21%) were seen in all patients. The treatment with ciclosporin has been continued in all 6 patients, but the dosage has been reduced to 5 mg/kg/day. Deterioration 3-4 weeks after discontinuation of ciclosporin was seen in one case, but resumption of therapy resulted in improvement as before. The total treatment period is now 24-34 months (March, 1987).(ABSTRACT TRUNCATED AT 250 WORDS)