Low-dose tacrolimus treatment in thymectomised and steroid-dependent myasthenia gravis

OBJECTIVES: The effects of tacrolimus, a new immunosuppressive drug, which inhibits calcineurin pathway and also might enhance corticosteroid (CS) receptor-mediated gene expressions, on clinical outcome and biochemical data were evaluated in thymectomised and steroid-dependent myasthenia gravis (MG) patients. PATIENTS AND METHODS: We administrated low-dose tacrolimus (3 mg/day orally) to 17 steroid-dependent thymectomised MG patients. They were followed for 4 to 58 months, average 19.2 months. The MG activities of daily living (MGADL) scores and the dosage of prednisolone (PSL) were assessed at baseline and 4 months later. RESULTS: The average MGADL scores improved from 6.8 to 5.0 (p < 0.01) at 4 months; to 3.5 at the last visit (p < 0.01) as well as the average dosage of PSL reducing from 31.6 to 24.1 mg/alternate day (p < 0.01) at 4 months; 14.6 mg at the last visit (p < 0.01). CONCLUSIONS: The additional low dose tacrolimus therapy for steroid-dependent thymectomised MG is effective in improving symptoms as well as allowing the tapering of CSs.