دورية أكاديمية
Comparison of Corticosteroid Tapering Regimens in Myasthenia Gravis
| العنوان: | Comparison of Corticosteroid Tapering Regimens in Myasthenia Gravis |
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| المؤلفون: | Sharshar, Tarek, Porcher, Raphaël, Demeret, Sophie, Tranchant, Christine, Gueguen, Antoine, Eymard, Bruno, Nadaj-Pakleza, Aleksandra, Spinazzi, Marco, Grimaldi, Lamiae, Birnbaum, Simone, Friedman, Diane, Clair, Bernard |
| المساهمون: | Hôpital Raymond Poincaré Garches, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Pasteur Paris (IP), Centre Hospitalier Sainte Anne Paris, Hôpital Hôtel-Dieu Paris, Université Paris Descartes - Paris 5 (UPD5), Service de Neurologie CHU Pitié-Salpêtrière, IFR70-CHU Pitié-Salpêtrière AP-HP, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université (SU), CHU Strasbourg, Fondation Ophtalmologique Adolphe de Rothschild Paris, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Hôpital Ambroise Paré AP-HP, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), CHU Pitié-Salpêtrière AP-HP, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de Myologie, Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Association française contre les myopathies (AFM-Téléthon)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Hôpital Raymond Poincaré AP-HP, MYACOR Study Group: Philippe Aegerter, Djillali Annane, Anne-Catherine Aubé-Nathier, Francis Bolgert, Marie Fleury, Marie-Christine Durand, Pierre-Marie Gonnaud, Catherine Goulon-Goeau, Olivier Gout, Frédéric Lofaso, Christophe Marcel, Vivien Pautot, Isabelle Penisson-Besnier, Hélène Prigent, Benjamin Rohaut, Christophe Vial, Nicolas Weiss |
| المصدر: | ISSN: 2168-6149. |
| بيانات النشر: | HAL CCSD American Medical Association |
| سنة النشر: | 2021 |
| المجموعة: | Archive ouverte HAL (Hyper Article en Ligne, CCSD - Centre pour la Communication Scientifique Directe) |
| مصطلحات موضوعية: | [SDV]Life Sciences [q-bio] |
| الوصف: | International audience ; Importance: The tapering of prednisone therapy in generalized myasthenia gravis (MG) presents a therapeutic dilemma; however, the recommended regimen has not yet been validated.Objective: To compare the efficacy of the standard slow-tapering regimen of prednisone therapy with a rapid-tapering regimen.Design: From June 1, 2009, to July 31, 2013, a multicenter, parallel, single-blind randomized trial was conducted to compare 2 regimens of prednisone tapering. Data analysis was conducted from February 18, 2019, to January 23, 2020. A total of 2291 adults with a confirmed diagnosis of moderate to severe generalized MG at 7 specialized centers in France were assessed for eligibility.Interventions: The slow-tapering arm included a gradual increase of the prednisone dose to 1.5 mg/kg every other day and a slow decrease once minimal manifestation status of MG was attained. The rapid-tapering arm consisted of immediate high-dose daily administration of prednisone, 0.75 mg/kg, followed by an earlier and rapid decrease once improved MG status was attained. Azathioprine, up to a maximum dose of 3 mg/kg/d, was prescribed for all participants.Main outcomes and measures: The primary outcome was attainment of minimal manifestation status of MG without prednisone at 12 months and without clinical relapse at 15 months. Intention-to-treat analysis was conducted.Results: Of the 2291 patients assessed, 2086 did not fulfill the inclusion criteria, 87 declined to participate, and 1 patient registered after trial closure. A total of 117 patients (58 in the slow-tapering arm and 59 in the rapid-tapering arm) were selected for inclusion by MG specialists and were randomized. The population included 62 men (53%); median age was 65 years (interquartile range, 35-69 years). The proportion of patients having met the primary outcome was higher in the rapid- vs slow-tapering arm (23 [39%] vs 5 [9%]), with a risk ratio of 3.61 (95% CI, 1.64-7.97; P < .001) after adjusting for center and thymectomy. The rapid-tapering ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| العلاقة: | info:eu-repo/semantics/altIdentifier/pmid/33555314; hal-03981526; https://hal.sorbonne-universite.fr/hal-03981526Test; PUBMED: 33555314; PUBMEDCENTRAL: PMC7871208 |
| DOI: | 10.1001/jamaneurol.2020.5407 |
| الإتاحة: | https://doi.org/10.1001/jamaneurol.2020.5407Test https://hal.sorbonne-universite.fr/hal-03981526Test |
| رقم الانضمام: | edsbas.953982B4 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1001/jamaneurol.2020.5407 |
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