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Rapid prednisone tapering safe in patients with myasthenia gravis

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Rapid tapering of prednisone in patients with moderate to severe generalized myasthenia gravis (MG) who require high-dose prednisone with azathioprine therapy is associated with good outcomes, according to a study in JAMA Neurology.

In this multicenter, parallel, single-blind randomized trial, 58 and 59 patients with MG were assigned to either the slow-tapering arm or the rapid-tapering arm, respectively.

Patients in the slow-tapering arm had a prednisone dose gradually increased to 1.5 mg/kg every other day and a slow decrease once minimal manifestation status of MG was attained. Patients in the rapid-tapering arm received immediate high-dose daily administration of prednisone, 0.75 mg/kg, followed by an earlier and rapid decrease once improved MG status was attained. All patients received azathioprine, up to a maximum dose of 3 mg/kg per day.

The primary outcome was achievement of minimal manifestation status of MG without prednisone at 12 months and without clinical relapse at 15 months and was met in 39% of patients in the rapid-tapering arm and 5% of patients in the slow-tapering arm.

After adjusting for center and thymectomy, the risk ratio of 3.61 (95% CI, 1.64-7.97; P < .001).

Over the course of 1 year, 1898 mg of prednisone was spared in the rapid-testing arm. There was no significant difference in serious adverse events between the groups.
Sharshar T, Porcher R, Demeret S, et al. Comparison of corticosteroid tapering regimens in myasthenia gravis: A randomized clinical trial. JAMA Neurol. 2021;doi:10.1001/jamaneurol.2020.5407.