Abstract

This study aimed to investigate the timing of meeting the criteria for a status of "minimal manifestation (MM) or better" and the factors that influenced whether "MM or better status" or "MM or better status with an oral prednisolone (PSL) dose of 5mg/day or less (5-mg MM)" was met in patients with acetylcholine receptor (AChR) antibody-positive generalized myasthenia gravis (MG). We performed a retrospective study in 93 patients with AChR antibody-positive generalized MG who were followed for 3years after the start of immunotherapy. We reviewed clinical data, such as MG-related symptoms, the MG activities of daily living profile (MGADL) score, immunotherapy including the dose of PSL, and achievement of the status of MM or better at baseline and 3, 6, 12, 24, and 36months after treatment. An MM or better status was achieved in 60% of the patients 3months and in 90% of the patients 2years after initiating immunotherapy. At 2years, 60% of the patients had achieved the treatment goal, which was an "5-mg MM". More frequent plasmapheresis and higher dose of PSL within 3months after immunotherapy initiation were associated with difficulty in achieving the 5-mg MM status at 2years. Approximately 60% of the MG patients achieved the treatment goal within 2years after treatment. PSL dose and the cumulative number of plasmapheresis procedures at 3months after immunotherapy initiation may help identify treatment-resistant patients with MG.

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