Submitted by: Niranjan N. Singh, MD
Edited by: Betul Gondogdu, MD
Sharshar T, Porcher R, Demeret S, et al. Comparison of Corticosteroid Tapering Regimens in Myasthenia Gravis: A Randomized Clinical Trial. JAMA Neurol
. 2021;78(4):426-433. doi:10.1001/jamaneurol.2020.5407
This multicenter, parallel, single-blind randomized trial was conducted to compare the efficacy of the standard slow-tapering regimen of prednisone therapy with a rapid-tapering regimen in patients with generalized Myasthenia Gravis treated with Azathioprine (n=117). The slow-tapering arm included a gradual increase of the prednisone dose to 1.5 mg/kg every other day and a slow decrease once remission was achieved. The rapid-tapering arm consisted of immediate high-dose daily administration of prednisone, 0.75 mg/kg, followed by an earlier and rapid decrease.
The primary outcome was attainment of minimal manifestation status of MG without prednisone at 12 months and without clinical relapse at 15 months. The proportion of patients having met the primary outcome was higher in the rapid- vs slow-tapering arm. The number of serious adverse events did not differ significantly between the slow- vs rapid-tapering group.
Comments: In patients with moderate to severe generalized MG who require high-dose prednisone with azathioprine therapy, rapid tapering of prednisone appears to be feasible. Longer term follow up and larger sample size would be helpful for comparison of steroid related side effects between the 2 groups.
Articles of Similar Interest: Lee I, Kuo HC et al Minimal manifestation status and prednisone withdrawal in the MGTX trial. Neurology. 2020 Aug 11;95(6):e755-e766. doi: 10.1212/WNL.0000000000010031. Epub 2020 Jul 1. PubMed PMID: 32611638; PubMed Central PMCID: PMC7455358.