Abstract Details

Title Calcineurin Inhibitors Can Be Safely Reduced in Most Patients with Well-controlled Myasthenia Gravis.

Topic Autoimmune Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-101

Objective To analyze the frequency of exacerbation caused by dose reduction of calcineurin inhibitors (CNIs) in well-controlled myasthenia gravis (MG), and to determine predictive risk factors of the treatment-related exacerbation due to CNI reduction.

Background CNIs, tacrolimus and cyclosporine, are widely used immunosuppressive agents against MG. Once the treatment goal has been maintained for 6 months to 2 years, the CNI dose should be tapered slowly to the minimal effective amount. However, CNI reduction could be hesitated due to some risks of treatment-related exacerbation.

Design/Methods We retrospectively examined MG patients treated with CNIs, whose disease activity was stable. The treatment-related exacerbation was defined as worsening of the myasthenic symptom(s) in less than 3 months after CNI reduction.

Results One hundred and twenty-six (95%) patients out of 132 treated with tacrolimus and 32 (94%) out of 34 with cyclosporine did not experience the treatment-related exacerbation. Although 8 (5%) patients had experienced the exacerbation, symptoms were restored by increasing their CNIs to the previous dosage in most patients. No patients developed a crisis due to CNI reduction. In 115 anti-acetylcholine receptor antibody (AChRAb)-positive MG patients taking tacrolimus, the onset-age was younger (30.0 vs 56.0 year-old, p = 0.025) and the reduction dosage was higher (2.0 vs 1.0 mg/day, p = 0.002) in patients with treatment-related exacerbation than those without exacerbation. ROC analyses for onset-age and reduction dosage showed that the area under the curve was 0.80 (95% confidence interval (CI), 0.65-0.95) and 0.88 (95% CI, 0.82-0.94), respectively. The best cutoff value to obtain the highest Youden’s index was < 52-year-old (sensitivity, 57%; specificity, 100%) and > 1.5 mg (sensitivity, 80%; specificity, 100%).

Conclusions

Tacrolimus reduction is relatively safe in late onset AChRAb-positive patients and until 1.5 mg/day. With these limitations, CNI reduction is worthy to be tried in well-controlled MG patients.

Authors/Disclosures
Yuko Takahashi PRESENTER	No disclosure on file
Yoichiro Nishida	Yoichiro Nishida has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Satoshi Kuwabara	Satoshi Kuwabara has nothing to disclose.
Takanori Yokota, MD, PhD (Tokyo Medical and Dental University)	Dr. Yokota has nothing to disclose.

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