Myasthenia gravis steroid therapy

A controlled clinical trial has never been reported for any medical or surgical modality used to treat myasthenia gravis. All recommended regimens are empirical and experts disagree on treatments of choice. Treatment decisions should be based on knowledge of the natural history of disease in each patient and the predicted response to a specific form of therapy. Treatment goals must be individualized according to the severity of disease, the patient's age and sex, and the degree of functional impairment. The response to any form of treatment is difficult to assess because the severity of symptoms fluctuates. Spontaneous improvement, even remissions, occur without specific therapy, especially during the early stages of the disease.

Post-marketing reports of severe hepatotoxicity (including acute hepatitis and fatal events) have been received for patients treated with Levofloxacin. No evidence of serious drug-associated hepatotoxicity was detected in clinical trials of over 7,000 patients. Severe hepatotoxicity generally occurred within 14 days of initiation of therapy and most cases occurred within 6 days. Most cases of severe hepatotoxicity were not associated with hypersensitivity [see Other Serious And Sometimes Fatal Reactions ]. The majority of fatal hepatotoxicity reports occurred in patients 65 years of age or older and most were not associated with hypersensitivity. Levofloxacin should be discontinued immediately if the patient develops signs and symptoms of hepatitis [see ADVERSE REACTIONS ; PATIENT INFORMATION ].

During conventional pharmacologic dose corticosteroid therapy, ACTH production is inhibited with subsequent suppression of cortisol production by the adrenal cortex. Recovery time for normal HPA activity is variable depending upon the dose and duration of treatment. During this time the patient is vulnerable to any stressful situation. Although it has been shown that there is considerably less adrenal suppression following a single morning dose of prednisolone (10 mg) as opposed to a quarter of that dose administered every six hours, there is evidence that some suppressive effect on adrenal activity may be carried over into the following day when pharmacologic doses are used. Further, it has been shown that a single dose of certain corticosteroids will produce adrenal cortical suppression for two or more days. Other corticoids, including methylprednisolone, hydrocortisone, prednisone, and prednisolone, are considered to be short acting (producing adrenal cortical suppression for 1¼ to 1½ days following a single dose) and thus are recommended for alternate day therapy.

Caution should be used when high-dose prednisone is given to patients as up to 50% of patients may develop a transient deterioration with possible precipitation of MG crisis. The transient worsening usually occurs 5 to 10 days after dose initiation and lasts for about a week. For this reason, high-dose prednisone should be started in hospitalized patients receiving concurrent rapid induction immunotherapy. Alternatively, a slow dose escalation regimen should be used to reach a target dose of 1mg/kg (usually 50-80 mg/day) over 3 to 4 weeks. In patients with mild to moderate MG symptoms, a lower dose of 20 to 40 mg per day is sufficient.

Myasthenia gravis steroid therapy

myasthenia gravis steroid therapy

Caution should be used when high-dose prednisone is given to patients as up to 50% of patients may develop a transient deterioration with possible precipitation of MG crisis. The transient worsening usually occurs 5 to 10 days after dose initiation and lasts for about a week. For this reason, high-dose prednisone should be started in hospitalized patients receiving concurrent rapid induction immunotherapy. Alternatively, a slow dose escalation regimen should be used to reach a target dose of 1mg/kg (usually 50-80 mg/day) over 3 to 4 weeks. In patients with mild to moderate MG symptoms, a lower dose of 20 to 40 mg per day is sufficient.

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