Lu sur :https://www.ncbi.nlm.nih.gov/pubmed/29175893
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Imai T1,2, Utsugisawa K3, Murai H4, Tsuda E2, Nagane Y3, Suzuki Y5, Minami N6, Uzawa A7, Kawaguchi N8, Masuda M9, Konno S10, Suzuki H11, Akaishi T12, Aoki M12.
J Neurol Neurosurg Psychiatry. 2017 Nov 24. pii: jnnp-2017-316625. doi: 10.1136/jnnp-2017-316625.
We examined the correlation between the dosing regimen of oral prednisolone (PSL) and the achievement of minimal manifestation status or better on PSL ≤5 mg/day lasting >6 months (the treatment target) in patients with generalised myasthenia gravis (MG).
We classified 590 patients with generalised MG into high-dose (n=237), intermediate-dose (n=187) and low-dose (n=166) groups based on the oral PSL dosing regimen, and compared the clinical characteristics, previous treatments other than PSL and prognosis between three groups. The effect of oral PSL dosing regimen on the achievement of the treatment target was followed for 3 years of treatment.
To achieve the treatment target, ORs for low-dose versus high-dose regimen were 10.4 (P<0.0001) after 1 year of treatment, 2.75 (P=0.007) after 2 years and 1.86 (P=0.15) after 3 years; and those for low-dose versus intermediate-dose regimen were 13.4 (P<0.0001) after 1 year, 3.99 (P=0.0003) after 2 years and 4.92 (P=0.0004) after 3 years. Early combined use of fast-acting treatment (OR: 2.19 after 2 years, P=0.02; OR: 2.11 after 3 years, P=0.04) or calcineurin inhibitors (OR: 2.09 after 2 years, P=0.03; OR: 2.36 after 3 years, P=0.02) was associated positively with achievement of treatment target.
A low-dose PSL regimen with early combination of other treatment options may ensure earlier achievement of the treatment target in generalised MG