Effectiveness of early glucocorticoids in myasthenia gravis: a retrospective cohort study

Lulu Zhen; Xue Zhao; Wenbo Li; Jinru Wu; Haodong Shang; Shufan Chen; Xiaoyan Zhu; Yiren Wang; Xiaoxiao Yu; Guanlian Hu; Zhan Sun; Yingna Zhang; Jing Zhang; Hua Fang; Yunke Zhang; Qingyong Zhang; Xinzheng Cui; Jie Lv; Junhong Yang; Feng Gao

doi:10.3389/fneur.2023.1259484

Effectiveness of early glucocorticoids in myasthenia gravis: a retrospective cohort study

Front Neurol. 2023 Dec 19:14:1259484. doi: 10.3389/fneur.2023.1259484. eCollection 2023.

Authors

Lulu Zhen^#^{1

2}, Xue Zhao^#², Wenbo Li^{1

2}, Jinru Wu^{2

3}, Haodong Shang^{2

4}, Shufan Chen^{2

4}, Xiaoyan Zhu^{1

2}, Yiren Wang^{2

3}, Xiaoxiao Yu^{2

4}, Guanlian Hu^{2

4}, Zhan Sun^{2

4}, Yingna Zhang², Jing Zhang², Hua Fang², Yunke Zhang⁵, Qingyong Zhang⁶, Xinzheng Cui⁶, Jie Lv², Junhong Yang⁵, Feng Gao²

Affiliations

¹ Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
² Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China.
³ Basic Medical College, Zhengzhou University, Zhengzhou, China.
⁴ BGI College, Zhengzhou University, Zhengzhou, China.
⁵ Department of Encephalopathy, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.
⁶ Myasthenia Gravis Comprehensive Diagnosis and Treatment Center, Henan Provincial People's Hospital, Zhengzhou, China.

^# Contributed equally.

Abstract

Purpose: This study aimed to clarify the effect of early glucocorticoid (GC) application on achieving minimal manifestation (MM) status or better in the treatment of myasthenia gravis (MG) in the early clinical phase.

Methods: A retrospective analysis was performed using data from 336 patients with MG who received GC therapy from January 2015 to September 2022 in the Zhengzhou University Henan Institute of Medical and Pharmaceutical Sciences Myasthenia Gravis Biobank (ZMB). Patients were divided into two groups: the early mono-GC group (treated with GC within 6 months of MG onset) and the delayed mono-GC group.

Results: Kaplan-Meier analysis showed that the early mono-GC group achieved MM status earlier and more frequently than the delayed mono-GC group (log-rank test, p = 0.0082; hazard ratio [HR], 1.66; p = 0.011). The early mono-GC group had a lower maintenance oral GC dose than the delayed mono-GC group. In multivariate Cox regression analysis, early mono-GC (HR, 1.50; p = 0.043), early-onset MG (EOMG) (HR, 1.74; p = 0.034), and ocular MG (OMG) (HR, 1.90; p = 0.007) were associated with MM status or better. In conclusion, early mono-GC, EOMG, and OMG were positive predictors of treatment goals. In EOMG, OMG, and acetylcholine receptor antibody-positive MG (AChR-MG) subgroups, the maintenance oral GC doses in the early mono-GC group were significantly lower than the doses in the delayed mono-GC group (p < 0.05).

Conclusion: Early intervention with GC led to better long-term outcomes and reduced the necessary maintenance dose of oral GC for patients with MG. EOMG and OMG were positive predictors of MM status or better with mono-GC.

Keywords: delayed treatment with GC; early treatment with GC; glucocorticoids; myasthenia gravis; prognostic factors; treatment target.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by projects of Basic Research Fund of Henan Institute of Medical and Pharmacological Sciences (grant numbers 2022BP0116 and 2023BP0201); Henan Province scientific and technological research grant (grant numbers 232102310408 and 232102311196); Special project of Henan Province of Traditional Chinese Medicines scientific research (20-21ZY1044).