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Methotrexate in generalized myasthenia gravis: a systematic review

Methotrexate in generalized myasthenia gravis: a systematic review Current myasthenia gravis guidelines recommend the use of azathioprine as first-line steroid sparing agent. However, due to its high cost, compliance to azathioprine is low in developing countries. To determine the efficacy and safety of the cheaper methotrexate as an alternative immunosuppressant, Medline/Pubmed, Embase and Cochrane databases and references were searched for clinical trials and observational studies using the search terms: “Myasthenia OR Myasthenia Gravis OR anti AchR antibody positive Myasthenia Gravis OR anti-MuSK antibody Myasthenia Gravis OR MG” AND “Methotrexate”. Of 78 possible articles, only 4 were selected using the following eligibility criteria: population: generalized MG patients; intervention: methotrexate; and outcome: effectiveness, steroid sparing efficacy and adverse effects. Two clinical trials and one observational study noted improvement in different MG outcomes in patients given methotrexate. While one randomized controlled clinical trial concluded that methotrexate has no steroid sparing benefit, a single blinded clinical trial established that methotrexate was a better steroid sparing agent than azathioprine starting at 10th month of use. Adverse effects were rare with non-specific pain and elevated transaminases as the most common complaints. Based on available evidence, MTX may be a safe and effective alternative to AZA as steroid sparing agent in developing countries. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Acta Neurologica Belgica Springer Journals

Methotrexate in generalized myasthenia gravis: a systematic review

Prado, Mario B.; Adiao, Karen Joy B.
Acta Neurologica Belgica , Volume OnlineFirst – Mar 27, 2023
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Publisher
Springer Journals
Copyright
Copyright © The Author(s) under exclusive licence to Belgian Neurological Society 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
ISSN
0300-9009
eISSN
2240-2993
DOI
10.1007/s13760-023-02242-w
Publisher site
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Abstract

Current myasthenia gravis guidelines recommend the use of azathioprine as first-line steroid sparing agent. However, due to its high cost, compliance to azathioprine is low in developing countries. To determine the efficacy and safety of the cheaper methotrexate as an alternative immunosuppressant, Medline/Pubmed, Embase and Cochrane databases and references were searched for clinical trials and observational studies using the search terms: “Myasthenia OR Myasthenia Gravis OR anti AchR antibody positive Myasthenia Gravis OR anti-MuSK antibody Myasthenia Gravis OR MG” AND “Methotrexate”. Of 78 possible articles, only 4 were selected using the following eligibility criteria: population: generalized MG patients; intervention: methotrexate; and outcome: effectiveness, steroid sparing efficacy and adverse effects. Two clinical trials and one observational study noted improvement in different MG outcomes in patients given methotrexate. While one randomized controlled clinical trial concluded that methotrexate has no steroid sparing benefit, a single blinded clinical trial established that methotrexate was a better steroid sparing agent than azathioprine starting at 10th month of use. Adverse effects were rare with non-specific pain and elevated transaminases as the most common complaints. Based on available evidence, MTX may be a safe and effective alternative to AZA as steroid sparing agent in developing countries.

Journal

Acta Neurologica Belgica – Springer Journals

Published: Mar 27, 2023

Keywords: Methotrexate; Myasthenia gravis; Steroid sparing agent; Systematic review; Developing countries

References

  • Treatment of autoimmune myasthenia gravis
    Richman, DP; Agius, MA
  • International consensus guidance for management of myasthenia gravis: 2020 update
    Narayanaswami, P; Sanders, DB; Wolfe, G
  • Guidelines for the treatment of autoimmune neuromuscular transmission disorders
    Skeie, GO; Apostolski, S; Evoli, A
  • Views & Reviews International consensus guidance for management of myasthenia gravis executive summary
    Sanders, DB; Wolfe, GI; Benatar, M
  • Treatment strategies for myasthenia gravis: an update
    Díaz-Manera, J; Rojas García, R; Illa, I
  • A practical approach to managing patients with myasthenia gravis—opinions and a review of the literature
    Farrugia, ME; Goodfellow, JA
  • Myasthenia gravis
    Gilhus, NE; Tzartos, S; Evoli, A; Palace, J; Burns, TM; Verschuuren, JJGM
  • Steroids and immunosuppressant drugs in myasthenia gravis
    Sathasivam, S
  • A randomized double-blind trial of prednisolone alone or with azathioprine in myasthenia gravis
    Palace, J; Newsom-Davis, J; Lecky, B
  • Immunosuppressive agents for myasthenia gravis
    Hart, IK; Sathasivam, S; Sharshar, T
  • A single-blinded trial of methotrexate versus azathioprine as steroid-sparing agents in generalized myasthenia gravis
    Heckmann, JM; Rawoot, A; Bateman, K; Renison, R; Badri, M
  • Methotrexate versus azathioprine in the treatment of rheumatoid arthritis A forty-eight–week randomized, double-blind trial
    Jeurissen, MEC; Th. Boerbooms, AM; van de Putte, LBA
  • A randomized controlled trial of methotrexate for patients with generalized myasthenia gravis
    Pasnoor, M; He, J; Herbelin, L
  • The Treatment of Severe Myasthenia Gravis with Immunosuppressive Agents
    Mertens, HG; Balzereit, F; Leipert, M
  • Methotrexate Treatment in Myasthenia Gravis
    Karaahmet, OZ; Bal, A; Dulgeroglu, D; Bahceci, HK; Cakci, A
  • Phase II trial of methotrexate in myasthenia gravis
    Pasnoor, M; He, J; Herbelin, L; Dimachkie, M; Barohn, RJ
  • Progress in the treatment of myasthenia gravis
    Gold, R; Hohlfeld, R; Toyka, KV
  • Clinical profile and outcome of postthymectomy versus non-thymectomy myasthenia gravis patients in the Philippine general hospital: A 6-year retrospective study
    de Roxas, RC; Bagnas, MAC; Baldonado, JJAR; Rivera, JP; Roxas, AA
  • Cost of Parkinson’s disease among Filipino patients seen at a public tertiary hospital in Metro Manila
    Prado, M; Jamora, RD