Rapid prednisone tapering safe in patients with myasthenia gravis

Rapid tapering of prednisone in patients with moderate to severe generalized myasthenia gravis (MG) who require high-dose prednisone with azathioprine therapy is associated with good outcomes, according to a study in JAMA Neurology.

In this multicenter, parallel, single-blind randomized trial, 58 and 59 patients with MG were assigned to either the slow-tapering arm or the rapid-tapering arm, respectively.

Patients in the slow-tapering arm had a prednisone dose gradually increased to 1.5 mg/kg every other day and a slow decrease once minimal manifestation status of MG was attained. Patients in the rapid-tapering arm received immediate high-dose daily administration of prednisone, 0.75 mg/kg, followed by an earlier and rapid decrease once improved MG status was attained. All patients received azathioprine, up to a maximum dose of 3 mg/kg per day.

The primary outcome was achievement of minimal manifestation status of MG without prednisone at 12 months and without clinical relapse at 15 months and was met in 39% of patients in the rapid-tapering arm and 5% of patients in the slow-tapering arm.

After adjusting for center and thymectomy, the risk ratio of 3.61 (95% CI, 1.64-7.97; P < .001).

Over the course of 1 year, 1898 mg of prednisone was spared in the rapid-testing arm. There was no significant difference in serious adverse events between the groups.
Reference
Sharshar T, Porcher R, Demeret S, et al. Comparison of corticosteroid tapering regimens in myasthenia gravis: A randomized clinical trial. JAMA Neurol. 2021;doi:10.1001/jamaneurol.2020.5407.