Initial low dose prednisone effective in immunosuppression in ocular myasthenia gravis

USA: The results of a new retrospective study show that initial therapy for ocular myasthenia gravis with a mean maximum daily prednisone dose of 10 mg seemed to be equally efficacious as a mean maximum daily dose of 29 mg for control at 1 month.

Ocular myasthenia is an autoimmune disorder characterized by double vision or ptosis. It frequently necessitates prednisone medication for immunosuppression, although there have been no prospective studies to assist doctors in determining the optimal dose.

This study was performed by Yesha S. Shah and the team with the objective to check the dose-dependent effect of prednisone on Ocular Myasthenia Gravis. The findings of this study were published in the Journal of Neuro-Ophthalmology, in the month of December 2021.

This was retrospective research that compared myasthenia symptom management at 1 month in individuals treated with a maximum daily equivalent dose of prednisone less than 20 mg (low-dose group) against 20 mg or more (high-dose group) (medium-dose group).

The findings of this study were as follows:

1. There were 39 patients in total: 19 in the low-dosage group with a mean maximum daily dose of 10 mg and 20 in the medium-dose group with a mean maximum daily dose of 29 mg.

2. At one month, the low-dose group was 75% controlled or considerably improved, while the medium-dose group was 74% controlled or greatly improved.

3. The overall seropositivity rate was 64%, with 84% of the antibody-positive group controlled or significantly improved after one month and 57% of the antibody-negative group controlled or significantly improved after one month, and no difference in prednisone dosing between the two groups.

In conclusion, These findings have significant implications for the treatment of ocular myasthenia, particularly considering the severe side effects associated with high-dose steroids. Additional study is needed to provide more supporting data on medication dosage dependency in patients with ocular myasthenia gravis.

Reference:

Shah, Yesha S. BBA, BSA; Henderson, Amanda D. MD; Carey, Andrew R. MD Effect of Initial Prednisone Dosing on Ocular Myasthenia Gravis Control, Journal of Neuro-Ophthalmology: December 2021 - Volume 41 - Issue 4 - p e622-e626 doi:10.1097/WNO.0000000000001058