[Pubmed] Factors associated with initial exacerbation after corticosteroids treatment in myasthenia gravis patients with
Posté : 10 mai 2026 12:00
J Clin Neurosci. 2026 May 9;151:112067. doi: 10.1016/j.jocn.2026.112067. Online ahead of print.
ABSTRACT
BACKGROUND: Corticosteroid (CS) administration is a fundamental immunotherapy for myasthenia gravis (MG), but it may temporarily worsen symptoms, especially in patients with bulbar symptoms, and even lead to myasthenic crisis (MC).
OBJECTIVE: To investigate factors associated with initial exacerbation after CS treatment in MG patients with bulbar symptoms, with a particular focus on comparing the risk between two initial CS regimens: intravenous methylprednisolone (IVMP) pulse regimen versus oral CS regimen.
DESIGN: A single-center retrospective study.
METHODS: We conducted a retrospective cohort study of 119 bulbar MG patients who received CS treatment between 2012 and 2023. We observed an initial exacerbation after CS administration. Univariate analysis and multiple logistic regression models were used to determine the associated factors for initial exacerbation and severe exacerbation after CS treatment.
RESULTS: 62 (52.1%) patients experienced an initial exacerbation after CS treatment, while 16 (13.5%) experienced a severe exacerbation. The median onset of initial exacerbation after CS treatment was day 3. The median duration of initial exacerbation was 3.5 days. The rates of initial exacerbation and severe exacerbation in the IVMP group were significantly higher than those in the oral CS group (74.2% vs. 44.3% and 29.0% vs. 8.0%, respectively). Multivariate logistic regression analysis revealed IVMP regimen (OR4.902, 95%CI 1.774-13.541, p = 0.002) and reduced biting strength/difficulty (OR7.286, 95%CI 2.036-26.071, p = 0.002) were factors independently associated with initial exacerbation. For severe exacerbation, IVMP regimen (OR7.695, 95%CI 1.394-42.464, p = 0.019), reduced cough strength (OR11.558, 95%CI 1.392-95.937, p = 0.023), and maximal voluntary ventilation (MVV) ≤ 60%(OR8.213,95%CI 1.637-41.217, p = 0.011) were independently associated factors.
CONCLUSIONS: IVMP regimen is associated with initial exacerbation after CS treatment in bulbar MG patients. Caution should be exercised when using IVMP regimen in clinical practice for bulbar MG patients, especially in those with reduced cough strength and low MVV.
PMID:42107209 | DOI:10.1016/j.jocn.2026.112067
Source: https://pubmed.ncbi.nlm.nih.gov/4210720 ... 7&v=2.20.0