Study Comparing Two Tapering Strategies of Prednisone in Myasthenia Gravis
Status:
Completed
Trial end date:
2017-09-01
Target enrollment:
Participant gender:
Summary
Pathology - Generalized myasthenia gravis (MG) is cause of muscle weakness that can have a
significant impact on daily life activity but can also be, when respiratory or bulbar muscles
are involved, life-threatening.
Rationale - Additionally to thymectomy, which indication of is still debated in absence of
thymoma, the long-term treatment of generalized myasthenia gravis includes usually prednisone
and azathioprine. However, the most used scheme for prescribing and tapering corticosteroid
in MG resulted in a very important cumulative dose of prednisone. Indeed, at twelve month,
more than 50 percent of patients are still daily treated with at least 18 mg of prednisone
and the proportion of patients who are in remission and no longer taking prednisone is very
low (Palace and NEWSOM Davis, Neurology 1998). Prolonged corticosteroid therapy is
accompanied with various and major side effects, hypertension, osteoporosis, weight gain,
glaucoma. Therefore, tapering, eventually discontinuing, prednisone earlier is a relevant
therapeutic goal.
For this reason, the investigators will compare to the standard one, a strategy consisting of
a rapid decrease in corticosteroid.
Objective - To assess whether, in patients with generalized MG requiring a long-term
treatment with corticosteroids and azathioprine, that the strategy of rapid tapering allows
discontinuing more rapidly the prednisone for equivalent efficacy than the classical
strategy.