Yonsei Med J.  2019 Jul;60(7):633-639. 10.3349/ymj.2019.60.7.633.

Long-Term Safety and Efficacy of Tacrolimus in Myasthenia Gravis

Affiliations
  • 1Department of Neurology, College of Medicine, Korea University Ansan Hospital, Ansan, Korea.
  • 2Department of Neurology, Yonsei University College of Medicine, Seoul, Korea. hayshin@yuhs.ac

Abstract

PURPOSE
Myasthenia gravis (MG) is a lifelong autoimmune disorder that affects neuromuscular transmission. The long-term treatment plan should include immunotherapy. We investigated the long-term safety and efficacy of tacrolimus for the treatment of MG in real-world clinical practice.
MATERIALS AND METHODS
We retrospectively reviewed 160 MG patients treated with tacrolimus from 2005 to 2015. Myasthenia Gravis Foundation of America (MGFA) clinical classification, MGFA post-intervention status, myasthenic functional score, and dose of oral prednisolone were investigated.
RESULTS
Adverse events occurred in 68 patients (42.5%), most of which were minor and well-managed. Clinical severity scales improved after administration of tacrolimus, compared to the baseline. Compared to 6 months before administration of tacrolimus, prednisolone dose significantly decreased at 12 months after treatment (2.85±0.92 mg/day, p=0.002), 18 months after treatment (3.36±0.99 mg/day, p=0.001), and 24 months after treatment (3.71±0.93 mg/day, p<0.001).
CONCLUSION
Tacrolimus may be effective in reducing the severity of MG and may permit a reduction in the steroid dose prescribed to the patients. Adverse events due to tacrolimus treatment were not serious.

Keyword

Myasthenia gravis; tacrolimus; steroid

MeSH Terms

Americas
Classification
Humans
Immunotherapy
Myasthenia Gravis*
Prednisolone
Retrospective Studies
Tacrolimus*
Weights and Measures
Prednisolone
Tacrolimus

Figure

  • Fig. 1 Adverse effects leading to cessation of tacrolimus according to the duration of tacrolimus treatment. Twenty-three patients stopped medication due to adverse effects.

  • Fig. 2 MGFA clinical classification (A), MGFA-PIS (B), and MFS distribution (C) before and after tacrolimus treatment. MGFA, Myasthenia Gravis Foundation of America; MGFA-PIS, MGFA post-intervention status; MFS, Myasthenic Functional Score.

  • Fig. 3 Prednisolone dose before and after tacrolimus administration. Prednisolone dose while taking tacrolimus was lower than the dose before tacrolimus administration.


Cited by  1 articles

Safety of Tacrolimus in Autoimmune Disease: Results From Post-marketing Surveillance in South Korea
Wan-Hee Yoo, Sang-Il Lee, Tae-Hwan Kim, Jung-Joon Sung, Seung Min Kim, Fan Hua, Budiwan Sumarsono, Sung Hwan Park
J Rheum Dis. 2021;28(4):202-215.    doi: 10.4078/jrd.2021.28.4.202.


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