Intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis

Abstract Corticosteroids may produce a paradoxical worsening of myasthenia gravis (MG) symptoms within the first weeks of treatment. We therefore wanted to assess the hypothesis that a prior infusion of intravenous immunoglobulin (IVIG) may have a protective effect. Our primary objectives were to sh...

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Autores principales:	Laura Díez-Porras, Christian Homedes, Maria Antonia Alberti, Valentina Vélez-Santamaría, Carlos Casasnovas
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2020
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/242967baf4764d01abfbcf9b81b6a5e2
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spelling	oai:doaj.org-article:242967baf4764d01abfbcf9b81b6a5e22021-12-02T18:50:55ZIntravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis10.1038/s41598-020-70539-42045-2322https://doaj.org/article/242967baf4764d01abfbcf9b81b6a5e22020-08-01T00:00:00Zhttps://doi.org/10.1038/s41598-020-70539-4https://doaj.org/toc/2045-2322Abstract Corticosteroids may produce a paradoxical worsening of myasthenia gravis (MG) symptoms within the first weeks of treatment. We therefore wanted to assess the hypothesis that a prior infusion of intravenous immunoglobulin (IVIG) may have a protective effect. Our primary objectives were to show that the coadministration of immunoglobulins and glucocorticoids is safe and effective for controlling myasthenic symptoms, and to compare the exacerbation rate with this approach and historical practice without IVIG. We recruited 45 patients with generalized MG who required corticosteroids for the first time and we gave all IVIG before starting the full doses of prednisone. Monitoring was performed with validated scales, questionnaires, and blood tests over a 6-week period. Only 4.4% had severe adverse effects related to IVIG and 86.7% improved clinically. Notably, only 2.2% had a paradoxical symptom exacerbation in the first weeks of starting prednisone, which was statistically lower than the 42% reported in a historical series. We conclude that adjuvant therapy with IVIG when starting prednisone for the first time in patients with generalized MG is safe and effective. Given that the rate of paradoxical worsening was lower than that previously reported, the addition of IVIG may have a protective effect against such exacerbations.Laura Díez-PorrasChristian HomedesMaria Antonia AlbertiValentina Vélez-SantamaríaCarlos CasasnovasNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 10, Iss 1, Pp 1-8 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Laura Díez-Porras Christian Homedes Maria Antonia Alberti Valentina Vélez-Santamaría Carlos Casasnovas Intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis
description	Abstract Corticosteroids may produce a paradoxical worsening of myasthenia gravis (MG) symptoms within the first weeks of treatment. We therefore wanted to assess the hypothesis that a prior infusion of intravenous immunoglobulin (IVIG) may have a protective effect. Our primary objectives were to show that the coadministration of immunoglobulins and glucocorticoids is safe and effective for controlling myasthenic symptoms, and to compare the exacerbation rate with this approach and historical practice without IVIG. We recruited 45 patients with generalized MG who required corticosteroids for the first time and we gave all IVIG before starting the full doses of prednisone. Monitoring was performed with validated scales, questionnaires, and blood tests over a 6-week period. Only 4.4% had severe adverse effects related to IVIG and 86.7% improved clinically. Notably, only 2.2% had a paradoxical symptom exacerbation in the first weeks of starting prednisone, which was statistically lower than the 42% reported in a historical series. We conclude that adjuvant therapy with IVIG when starting prednisone for the first time in patients with generalized MG is safe and effective. Given that the rate of paradoxical worsening was lower than that previously reported, the addition of IVIG may have a protective effect against such exacerbations.
format	article
author	Laura Díez-Porras Christian Homedes Maria Antonia Alberti Valentina Vélez-Santamaría Carlos Casasnovas
author_facet	Laura Díez-Porras Christian Homedes Maria Antonia Alberti Valentina Vélez-Santamaría Carlos Casasnovas
author_sort	Laura Díez-Porras
title	Intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis
title_short	Intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis
title_full	Intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis
title_fullStr	Intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis
title_full_unstemmed	Intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis
title_sort	intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis
publisher	Nature Portfolio
publishDate	2020
url	https://doaj.org/article/242967baf4764d01abfbcf9b81b6a5e2
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Intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis

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