Efficacy of non–steroidal immunosuppressant in myasthenia gravis

Abstract

In Japan, the early fast–acting treatment strategy (EFT) has been proposed to reduce the side effects of steroids as well as to improve myasthenic symptoms ; as part of EFT, the use of non–steroidal immunosuppressive drugs is recommended early after the diagnosis of myasthenia gravis (MG).

Two types of calcineurin inhibitors (CNIs) are available in Japan : cyclosporine and tacrolimus. There are several randomized controlled trials suggesting a steroid–sparing effect, improvement of MG symptoms, and reduction of anti–acetylcholine receptor antibody titers by CNIs. CNIs are limited to the dose used for MG, but it is well tolerated without serious side effects.

In other countries, azathioprine and mycophenolate mofetil are used as non–steroidal immunosuppressants. These drugs are also options for refractory cases, but they are not indicated for use in Japan.