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

Abstract

Abstract 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. A retrospective analysis was performed on 366 patients with MG who had received immunotherapy in the Henan Institute of Medical and Pharmaceutical Sciences Myasthenia Gravis Biobank from January 2015 to September 2022. Patients were divided into two groups: the early mono-GC group (treated with GC within 6 months of MG onset) and delayed mono-GC group. Kaplan-Meier analysis showed that the early mono-GC group achieved MM status earlier and more frequently (Log-rank test, P = 0.0052; hazard ratio [HR], 1.59; P = 0.007). The early mono-GC group had a lower maintenance oral GC dose than delayed mono-GC group. In multivariate Cox regression analysis, early mono-GC (HR, 0.68; P = 0.026), early-onset MG (EOMG) (HR, 0.53; P = 0.004), ocular MG (OMG) (HR, 0.58; P = 0.002), and Myasthenia Gravis Foundation of America (MGFA) IV-V typing (HR, 2.51; P = 0.035) were associated with MM. In conclusion, EOMG, OMG, and low MGFA typing were positive predictors of treatment goals. Early intervention with GC leads to better long-term outcomes and reduces the necessary maintenance dose of oral GC for patients with MG.