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Research paper
Oral corticosteroid dosing regimen and long-term prognosis in generalised myasthenia gravis: a multicentre cross-sectional study in Japan
  1. Tomihiro Imai1,2,
  2. Kimiaki Utsugisawa3,
  3. Hiroyuki Murai4,
  4. Emiko Tsuda2,
  5. Yuriko Nagane3,
  6. Yasushi Suzuki5,
  7. Naoya Minami6,
  8. Akiyuki Uzawa7,
  9. Naoki Kawaguchi8,
  10. Masayuki Masuda9,
  11. Shingo Konno10,
  12. Hidekazu Suzuki11,
  13. Tetsuya Akaishi12,
  14. Masashi Aoki12
  1. 1Department of Occupational Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Japan
  2. 2Department of Neurology, Sapporo Medical University Hospital, Sapporo, Japan
  3. 3Department of Neurology, Hanamaki General Hospital, Hanamaki, Japan
  4. 4Department of Neurology, School of Medicine, International University of Health and Welfare, Narita, Japan
  5. 5Department of Neurology, Sendai Medical Center, Sendai, Japan
  6. 6Department of Neurology, Hokkaido Medical Center, Sapporo, Japan
  7. 7Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
  8. 8Neurology Chiba Clinic, Chiba, Japan
  9. 9Department of Neurology, Tokyo Medical University, Tokyo, Japan
  10. 10Department of Neurology, Toho University Ohashi Medical Center, Tokyo, Japan
  11. 11Department of Neurology, Kinki University School of Medicine, Osaka, Japan
  12. 12Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
  1. Correspondence to Professor Tomihiro Imai, Department of Occupational Therapy, Sapporo Medical University School of Health Sciences, Chuo-ku, Sapporo 060-8556, Japan; toimai{at}


Objective We examined the correlation between the dosing regimen of oral prednisolone (PSL) and the achievement of minimal manifestation status or better on PSL ≤5 mg/day lasting >6 months (the treatment target) in patients with generalised myasthenia gravis (MG).

Methods We classified 590 patients with generalised MG into high-dose (n=237), intermediate-dose (n=187) and low-dose (n=166) groups based on the oral PSL dosing regimen, and compared the clinical characteristics, previous treatments other than PSL and prognosis between three groups. The effect of oral PSL dosing regimen on the achievement of the treatment target was followed for 3 years of treatment.

Results To achieve the treatment target, ORs for low-dose versus high-dose regimen were 10.4 (P<0.0001) after 1 year of treatment, 2.75 (P=0.007) after 2 years and 1.86 (P=0.15) after 3 years; and those for low-dose versus intermediate-dose regimen were 13.4 (P<0.0001) after 1 year, 3.99 (P=0.0003) after 2 years and 4.92 (P=0.0004) after 3 years. Early combined use of fast-acting treatment (OR: 2.19 after 2 years, P=0.02; OR: 2.11 after 3 years, P=0.04) or calcineurin inhibitors (OR: 2.09 after 2 years, P=0.03; OR: 2.36 after 3 years, P=0.02) was associated positively with achievement of treatment target.

Conclusion A low-dose PSL regimen with early combination of other treatment options may ensure earlier achievement of the treatment target in generalised MG.

  • myasthenia gravis
  • prednisolone
  • calcineurin inhibitor
  • postintervention status
  • logistic regression analysis

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  • Contributors TI, KU, HM, ET and YN: involved in conception and design of the work. TI, KU, HM, ET, YN, YS, NM, AU, NK, MM, SK, HS, TA and MA: involved in acquisition of data. TI: involved in analysis and interpretation of data; drafted the article. All other coauthors: revised the article critically for important intellectual content.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The ethics committees of each of the participating institutions approved the study protocols.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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