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Induction cyclophosphamide with maintenance immunosuppression in high-risk myasthenia gravis: long-term follow-up and safety profile.
Chan, Fiona; Hardy, Todd A; Malik, Sameer; Ramanathan, Sudarshini; Riminton, D Sean; Reddel, Stephen W.
Afiliación
  • Chan F; Queen Elizabeth Hospital, Birmingham, UK.
  • Hardy TA; Department of Neurology, Concord Hospital, Concord, New South Wales, Australia.
  • Malik S; Department of Immunology, Concord Hospital, Concord, New South Wales, Australia.
  • Ramanathan S; Department of Neurology, Concord Hospital, Concord, New South Wales, Australia.
  • Riminton DS; University of Sydney, Sydney, New South Wales, Australia.
  • Reddel SW; Department of Immunology, Concord Hospital, Concord, New South Wales, Australia.
J Neurol Neurosurg Psychiatry ; 2024 Jul 04.
Article en En | MEDLINE | ID: mdl-38964847
ABSTRACT

BACKGROUND:

Patients with refractory or high-risk myasthenia gravis (MG) respond poorly to conventional immunosuppressive therapy, requiring rescue therapies and often experiencing treatment toxicity. Rescue and injectable therapies do not induce remission and require repetitive administration leading to significant constraints on patients and the healthcare system. This long-term follow-up study demonstrates cyclophosphamide as a rapidly effective and safe treatment in patients with refractory or high-risk MG.

METHODS:

Retrospective cohort study of MG patients treated with cyclophosphamide between January 2000 and June 2022 conducted at a quaternary neuroimmunology clinic in New South Wales, Australia.

RESULTS:

31 patients were treated mean age of 64 years; median follow-up 3.6 years (5 months to 11 years); 94% seropositive to acetylcholine receptor (AChR) antibodies and 45% had thymoma. A reduced intensity cyclophosphamide induction protocol followed by oral antiproliferative maintenance is described.Median myasthenia gravis composite scores reduced by >50% after the third cycle of cyclophosphamide. Complete cessation of prednisolone was possible in 11 patients while 20 remained on prednisolone with a median daily dose of 5 mg. Plasma exchange was ceased in 62% of patients and intravenous immunoglobulin ceased in 55%. Cyclophosphamide was generally well tolerated with mild cytopenias. There were no malignancies or cases of haemorrhagic cystitis.

CONCLUSION:

We describe a large cohort of high-risk MG patients treated with cyclophosphamide in a retrospective single-clinic cohort. We suggest cyclophosphamide should be considered for rapid remission induction, corticosteroid reduction and long-term freedom from recurrent injectable therapies in selected patients, typically those with AChR antibodies.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Neurol Neurosurg Psychiatry Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Neurol Neurosurg Psychiatry Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido