A UK national survey of 235 people with myasthenia gravis, 166 on azathioprine, 102 on mycophenolate and 40 on methotrexate, showed that :
- the most frequent adverse events were liver damage with azathioprine (23%), diarrhoea with mycophenolate (14%) and fatigue with methotrexate (18%);
- discontinuation of azathioprine due to adverse events was significantly more frequent than with mycophenolate or methotrexate;
- there was no significant difference between the three immunosuppressants in terms of discontinuation of treatment due to lack of efficacy;
- women experienced adverse events more frequently than men.
Until less toxic compounds are available, mycophenolate and methotrexate appear to be effective alternatives to azathioprine in the absence of pregnancy or breast-feeding.
