重症筋無力症治療の今後の方向性とアフェレシス

概要

論文の詳細を見る
Myasthenia gravis (MG) is seldom lethal today. However, full remission without immune treatment is still not common, and many patients find it difficult to maintain daily activities due to chronic residual fatigability and long-term side effects of oral corticosteroids. The dose of oral corticosteroids is one of the major factors negatively affecting the health-related quality of life (QOL) of MG patients, as well as disease severity. Our analysis demonstrated that QOL of minimal manifestations (MM) status patients taking prednisolne ≤ 5 mg/day is identically good as that seen in complete stable remission and that unchanged status and early disease stage are associated with a depressive state in MG patients. We therefore propose early achievement of MM or better status with prednisolne ≤ 5 mg/day as the first goal in MG therapy. In order to achieve early MM or better status with prednisolne ≤ 5 mg/day, we advocate the early aggressive treatment strategy that can achieve early improvement by performing an aggressive therapy using combined treatment with plasmapheresis and high-dose intravenous methylprednisolone and then maintenance of the improved status using low-dose oral corticosteroids and calcineurin inhibitors.
2013-10-31