A study carried out in France compared the withdrawal arrangements of corticosteroids in myasthenia gravis

Myasthenia gravis is a neuromuscular immune mediated disease particularly common in adulthood. It is caused by the deleterious action of antibodies produced by the individual and directed against one or more components of the neuromuscular junction. it results in fluctuating paralysis with a strong ocular and bulbar tropism. MG treatment is both symptomatic, with acetylcholine esterase inhibitors, and aetiological since it is an autoimmune disease most often sensitive to immunosuppressants. Corticosteroid therapy is frequently prescribed as an initial treatment, for many months or weeks with a significant risk of side effects. 

In this context, a network involving French clinicians was interested, in a comparative way, in the withdrawal of corticosteroids given to this type of patient From a group of 2291 patients followed for MG within the network, 117 with moderate or severe forms of the disease were selected to participate in a randomized study called MYACOR. In that study, the reduction in corticosteroid doses could be rapid or slower, the criteria to evaluate the respective effectiveness of these two protocols being the absence or near-absence of myasthenic manifestations at one year, and the non-occurrence of relapse at fifteen months. It should be noted that all the patients were treated with 3mg / kg / day of azathioprine as a supplement.

The authors conclude, with similar side effects, the superiority of rapid withdrawal which allows a lower cumulative exposure to cortisone derivatives.


Comparison of Corticosteroid Tapering Regimens in Myasthenia Gravis: A Randomized Clinical Trial. T Sharshar, R Porcher, S Demeret et al. JAMA Neurol. 2021 Feb 8.