Corticosteroid Rapid-Tapering Regimen in Myasthenia Gravis
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A new JAMA study states that the rapid tapering of prednisone therapy appears to be feasible, beneficial, and safe in patients with generalized myasthenia gravis and warrants testing in other autoimmune diseases.

This study was conducted to compare the efficacy of the standard slow-tapering regimen of prednisone therapy with a rapid-tapering regimen.

A multicenter, parallel, single-blind randomized trial was conducted to compare 2 regimens of prednisone tapering. A total of 2291 adults with a confirmed diagnosis of moderate to severe generalized MG at 7 specialized centers in France were assessed for eligibility.

A total of 117 patients (58 in the slow-tapering arm and 59 in the rapid-tapering arm) were selected for inclusion by MG specialists and were randomized. The primary outcome was the 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, with a risk ratio of 3.61 after adjusting for center and thymectomy.

--The rapid-tapering regimen allowed sparing of a mean of 1898 mg of prednisone over 1 year.

--The number of serious adverse events did not differ significantly between the slow- vs rapid-tapering group.

Conclusively, in patients with moderate to severe generalized MG who require high-dose prednisone with azathioprine therapy, rapid tapering of prednisone appears to be feasible, well-tolerated, and associated with a good outcome.