Outcome of Myasthenia gravis treated with high-dose prednisolone and azathioprine: A single centre ambispective study from India.

PURPOSE: Myasthenia gravis (MG) is treated with many disease modifying therapies, namely corticosteroids, thymectomy and immunosuppressants, alone or in various combinations. But still, till today no consensus over the optimum therapy for MG has been made.

METHODS: Out of total 101 patients with MG, 37 patients fulfilled the inclusion criteria and in them we ambispectively studied factors affecting the outcome in MG treated, to induce leukopenia, with prednisolone (PSL) plus azathioprine(AZA), from January 1993 through July 2014. Patients were grouped according to the outcome: pharmacological remission (PR), complete stable remission (CSR), non-remitter and remitters with or without relapse. Their demographic characteristics, MGFA Class, dose of PSL and AZA, time to achieve remission, duration of remission, leukocyte counts, thymus status, follow-up duration, results of repetitive nerve stimulation, and side effects profile were compared.

RESULTS: Total 81% patients remitted; PR (83%) was commoner than CSR (p=0.003). Factors favoring remission were early onset disease, therapeutic leukopenia (p=0.003) and longer follow-up (OR5, p=0.08); those associated with relapse were abnormal thymus (CI-1.1-3.4; p=0.09), MGFA class IIb (CI 0.9-3; p=0.09) and male gender. Side effects occurred in 48%.

CONCLUSION: Aggressive therapy with prednisolone plus azathioprine induces remission in a high percentage of patients with generalized MG.