Tacrolimus Monotherapy: A Promising Option for Ocular Myasthenia Gravis

Yagi, Yohsuke; Sanjo, Nobuo; Yokota, Takanori; Mizusawa, Hidehiro

doi:10.1159/000347068

Cited by 20 publications

(16 citation statements)

References 17 publications

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“…Tacrolimus has similar effect to cyclosporine and results in a significant reduction in the steroid dose. [ 60 61 62 ] It has less nephrotoxicity in comparison with cyclosporine. Methotrexate, rituximab, cyclophosphamide, and etanercept may also provide beneficial effects.…”

Section: Treatment Optionsmentioning

confidence: 99%

Update on ocular myasthenia gravis in Taiwan

Lin

Chen

Jou

et al. 2018

Taiwan J Ophthalmol

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Myasthenia gravis (MG) is an autoimmune disease involving the neuromuscular junction. Autoantibodies to the acetylcholine receptor or, less frequently, to muscle-specific kinase, attack against the postsynaptic junctional proteins, resulting in fluctuating and variable weakness of muscles. Extraocular, levator palpebrae superioris, and orbicularis oculi muscles are particularly susceptible. The majority of patients with MG present with purely ocular symptoms including ptosis and diplopia initially. About half of these patients progress to generalized disease within 2 years. The prevalence of MG in Taiwan is 140 per million with male to female ratio of 0.7. The incidence rate is higher in the elderly. Several immune-related diseases such as lymphoid malignancy, diabetes, and thyroid diseases are associated with MG in the national population-based studies in Taiwan. Ice pack test, rest test, Tensilon/neostigmine test, circulating antibody measurement, and electrophysiological studies are useful diagnostic tools with variable sensitivity and specificity. For the patients with ocular MG, acetylcholinesterase inhibitors are usually the first-line treatment. Corticosteroids and immunosuppressant could provide better disease control and may reduce the risk of conversion to generalized form although there is still some controversy. A thymectomy is also beneficial for ocular MG, especially in refractory cases. The correction of ptosis and strabismus surgery could improve the visual outcome but should be performed only in stable disease.

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Section: Treatment Optionsmentioning

confidence: 99%

Update on ocular myasthenia gravis in Taiwan

Lin

Chen

Jou

et al. 2018

Taiwan J Ophthalmol

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“…TAC is recommended to treat MG in different countries and the international MG treatment guidelines (2,16,17). Interestingly, four ocular MG (OMG) patients were reported to respond well to TAC alone (18). Meanwhile, CsA monotherapy could significantly improve MG symptoms in RCTs (19,20).…”

Section: Introductionmentioning

confidence: 99%

Favorable Effects of Tacrolimus Monotherapy on Myasthenia Gravis Patients

Fan

Shen

et al. 2020

Front. Neurol.

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Background and Purpose: Tacrolimus (TAC) has been proven to be a rapid-acting, steroid-sparing agent for myasthenia gravis (MG) therapy. However, evidence related to the effectiveness of TAC alone is rare. Therefore, this study was performed to investigate the effect of TAC monotherapy in MG patients. Methods: Forty-four MG patients who received TAC monotherapy were retrospectively analyzed. A mixed effect model was used to analyze improvements in MG-specific activities of daily living scale (MG-ADL), quantitative MG score (QMG) and MG-ADL subscores. Kaplan-Meier analysis was used to estimate the cumulative probability of minimal manifestations (MM) or better. Adverse events (AEs) were recorded for safety analyses. Results: Of the patients receiving TAC monotherapy, MG-ADL scores were remarkably improved at 3, 6 and 12 months compared with scores at baseline (mean difference and 95% CIs: −3.29 [−4.94, −1.64], −3.97 [−5.67, −2.27], and −4.67 [−6.48, −2.85], respectively). QMG scores significantly decreased at 6 and 12 months, with mean differences and 95% CIs of −4.67(−6.88, −2.45) and −5.77 (−7.55, −4.00), respectively. Estimated median period to achieve "MM or better" was 5.0 (95% CIs, 2.8, 7.2) months. Ocular MG (OMG) and generalized MG (GMG) showed similar therapeutic effects in cumulative probabilities of "MM or better" (P-value = 0.764). A better response was observed in MG-ADL subscores for ptosis and bulbar symptoms. AEs occurred in 37.5% of patients and were generally mild and reversible. Conclusions: TAC monotherapy is a promising option to rapidly alleviate all symptoms of MG, especially for ptosis and bulbar symptoms.

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“…147 It has been suggested as a monotherapy option in OMG. 148 Hyperglycemia is a well-known complication of tacrolimus. 98 Tacrolimus, similar to cyclosporine, is a calcineurin inhibitor that works by inhibiting T lymphocyte proliferation and the inhibition of calcium release from the sarcoplasmic reticulum in muscle cells.…”

Section: Tacrolimusmentioning

confidence: 99%

Myasthenia Gravis

Gwathmey

Burns

2015

Semin Neurol

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Myasthenia gravis is an autoimmune neuromuscular disease caused by antibodies directed against the postsynaptic muscle membrane. The clinical hallmark of the disease is fluctuating and fatigable weakness that affects the ocular muscles (resulting in diplopia and ptosis), the bulbar muscles (causing dysphagia, dysarthria, and dyspnea), and extremity muscles. The diagnosis is most often made with serological testing that identifies either acetylcholine receptor antibodies or muscle-specific tyrosine kinase antibodies. Electrodiagnostic testing has a role in supporting the diagnosis. There are many available treatments that result in improvement of function and quality of life. Treatment should be individualized after consideration of many factors, including disease distribution and severity, patient comorbidities, age, serological status, and what is known about the efficacy and safety of the various treatments.

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Tacrolimus Monotherapy: A Promising Option for Ocular Myasthenia Gravis

Cited by 20 publications

References 17 publications

Update on ocular myasthenia gravis in Taiwan

Update on ocular myasthenia gravis in Taiwan

Favorable Effects of Tacrolimus Monotherapy on Myasthenia Gravis Patients

Myasthenia Gravis

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