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Evidence summaries

Immunosuppressive Agents for Myasthenia Gravis

Ciclosporin as monotherapy or with corticosteroids and cyclophosphamide with corticosteroids may improve myasthenia gravis. Evidence on the benefit from azathioprine, mycophenolate mofetil or tacrolimus is insufficient. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 7 studies with a total of 205 subjects. Ciclosporin either as monotherapy (1 trial, n=20) or with corticosteroids (1 trial, n=39) resulted in improvement compared with placebo (relative rate of improvement 2.44, 95% confidence interval [CI] 1.13 to 5.27). The weighted mean difference in QMG (Quantitative MG Score for Disease Severity) score between the ciclosporin and placebo groups was -0.34 (95% CI -0.52 to -0.17). Azathioprine (plus prednisolone for the first month) had no significant benefit over prednisolone alone (n=41) in terms of treatment failure. Results with azathioprine plus prednisolone versus prednisolone plus placebo (n=34) were similar. The duration of remission was significantly longer in the azathioprine plus prednisolone group compared with the prednisolone plus placebo group (RR 0.28, 95% CI 0.08 to 0.94). Cyclophosphamide was reported to be statistically more efficacious than placebo at 12 months in corticosteroid-dependent participants (n=23), but data for individual participants were unavailable. Trials of mycophenolate mofetil and tacrolimus did not provide relevant endpoint data for the review.

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and by inconsistency (heterogeneity in interventions and outcomes).

    References

    • Hart IK, Sathasivam S, Sharshar T. Immunosuppressive agents for myasthenia gravis. Cochrane Database Syst Rev 2007 Oct 17;(4):CD005224. [PubMed]

Primary/Secondary Keywords