Document Detail

Tacrolimus for myasthenia gravis: a clinical study of 212 patients.
MedLine Citation:
PMID:  18096852     Owner:  NLM     Status:  MEDLINE    
Tacrolimus is a macrolide T cell immunomodulator that is used in myasthenia gravis (MG) patients to affect muscle contraction (ryanodine receptor by modulating intracellular calcium-release channels and increasing muscular strength), glucocorticoid receptors (increasing intracellular concentration of steroids and blocking the steroid export mechanism), and an increase in T cell apoptosis. In this study, we report the results of low-dose tacrolimus (0.1 mg/kg/day) treatment in 212 MG patients. There were 110 thymectomized, cyclosporine- and prednisone-dependent patients; 68 thymectomized patients who started tacrolimus early postoperatively (24 h after operation); and 34 patients over 60 years old with nonthymomatous generalized MG or in whom thymectomy was contraindicated. The mean follow-up time was 49.3 +/- 18.1 months. Muscular strength showed an increase of 23% after 1 month of treatment and 29% at the end of the study. The acetylcholine receptor antibodies decreased significantly from a mean of 33.5 nmol/L at base line to 7.8 nmol/L at the final visit. In the thymectomy group with combined prednisone and tacrolimus stratified by histology of the thymus, the mean probability to attain complete stable remission at 5 years was 80.8% in patients with hyperplasia, 48.1% in thymic involution, and 9.3% in patients with thymoma. In 4.9% of patients, tacrolimus was withdrawn because of major adverse effects. Our results suggest that a low dose of tacrolimus is effective for MG and could be included to the armamentarium for this autoimmune disease. The present results should be interpreted considering the limitations of a retrospective clinical study. Confirmation of these results in randomized studies is desirable.
José M Ponseti; Josep Gamez; Jamal Azem; Manuel López-Cano; Ramón Vilallonga; Manuel Armengol
Publication Detail:
Type:  Journal Article     Date:  2007-12-20
Journal Detail:
Title:  Annals of the New York Academy of Sciences     Volume:  1132     ISSN:  0077-8923     ISO Abbreviation:  Ann. N. Y. Acad. Sci.     Publication Date:  2008  
Date Detail:
Created Date:  2008-06-23     Completed Date:  2008-09-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7506858     Medline TA:  Ann N Y Acad Sci     Country:  United States    
Other Details:
Languages:  eng     Pagination:  254-63     Citation Subset:  IM    
Unit of Myasthenia Gravis, Department of Surgery, Hospital General Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, E-08035 Barcelona, Spain.
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MeSH Terms
Aged, 80 and over
Dose-Response Relationship, Drug
Immunosuppressive Agents / adverse effects,  therapeutic use
Middle Aged
Myasthenia Gravis / drug therapy*,  immunology*,  pathology,  surgery
Retrospective Studies
Tacrolimus / adverse effects,  therapeutic use*
Reg. No./Substance:
0/Immunosuppressive Agents; 109581-93-3/Tacrolimus

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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