Early high-dose intravenous methylprednisolone is associated with faster symptom improvement in persistent ocular myasthenia gravis: a single-center retrospective study
- 1Department of Neurology, National Hospital Organization Sendai Medical Center , ,
Abstract
Background: High-dose intravenous methylprednisolone pulse therapy (HMP) may provide rapid symptom relief in ocular myasthenia gravis (MG), but the clinical impact of its early use as induction immunotherapy remains unclear. We evaluated whether early HMP was associated with more rapid symptom improvement in patients with persistent ocular MG.
Methods: This single-center retrospective study included 36 patients with ocular MG who received corticosteroid-based immunotherapy and remained classified as having ocular MG throughout 2 years of follow-up. Patients were categorized according to their initial immunotherapy strategy into an early HMP induction group ( n = 19), which received HMP at oral prednisolone initiation or within 3 weeks thereafter, and an oral corticosteroid (OCS) induction group ( n = 17), which initially received OCS without HMP. Additional HMP during follow-up was permitted. The primary outcome was the longitudinal change in ocular MG Activities of Daily Living (MG-ADL) score over 24 months, analyzed using a linear mixed-effects model.
Results: Baseline ocular MG-ADL scores were higher in the HMP group (mean ± standard deviation, 4.842 ± 1.642 vs. 3.353 ± 1.057). The mixed-effects model demonstrated a significant group-by-time interaction ( p < 0.001). At 1 month, the least-squares mean ocular MG-ADL score was 0.474 (95% confidence interval [CI], 0.024–0.923) in the HMP group and 2.000 (95% CI, 1.525–2.475) in the OCS group, with a significant between-group difference after Tukey adjustment ( p < 0.001). From 3 months onward, scores remained low in both groups without significant between-group differences. The HMP group achieved minimal symptom expression earlier. Oral prednisolone doses and prednisolone-related adverse events did not differ significantly between groups. Initial worsening occurred in two HMP-treated patients, but neither developed myasthenic crisis.
Conclusion: In persistent ocular MG, early HMP as part of induction immunotherapy was associated with faster ocular symptom improvement and earlier achievement of minimal symptom expression than OCS induction alone, while long-term clinical outcomes and oral prednisolone doses were similar. Early HMP may be useful when rapid symptom control is required, although prospective studies are needed.
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BibTeX
@article{matsuo2026early,
title = {{Early high-dose intravenous methylprednisolone is associated with faster symptom improvement in persistent ocular myasthenia gravis: a single-center retrospective study}},
author = {Noritaka Matsuo and Genya Watanabe and Chihiro Sasaki and Ayane Tamagake and Moeko Saito and Kenichi Tsukita and Yasushi Suzuki},
journal = {Frontiers in neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1956054},
url = {https://europepmc.org/article/PMC/PMC13670919},
note = {CC BY},
}
RIS
TY - JOUR
TI - Early high-dose intravenous methylprednisolone is associated with faster symptom improvement in persistent ocular myasthenia gravis: a single-center retrospective study
AU - Noritaka Matsuo
AU - Genya Watanabe
AU - Chihiro Sasaki
AU - Ayane Tamagake
AU - Moeko Saito
AU - Kenichi Tsukita
AU - Yasushi Suzuki
PY - 2026
DA - 2026/10/01
JO - Frontiers in neurology
DO - 10.3389/fneur.2026.1956054
UR - https://europepmc.org/article/PMC/PMC13670919
AB - Background: High-dose intravenous methylprednisolone pulse therapy (HMP) may provide rapid symptom relief in ocular myasthenia gravis (MG), but the clinical impact of its early use as induction immunotherapy remains unclear. We evaluated whether early HMP was associated with more rapid symptom improvement in patients with persistent ocular MG. Methods: This single-center retrospective study included 36 patients with ocular MG who received corticosteroid-based immunotherapy and remained classified as having ocular MG throughout 2 years of follow-up. Patients were categorized according to their initial immunotherapy strategy into an early HMP induction group ( n = 19), which received HMP at oral prednisolone initiation or within 3 weeks thereafter, and an oral corticosteroid (OCS) induction group ( n = 17), which initially received OCS without HMP. Additional HMP during follow-up was permitted. The primary outcome was the longitudinal change in ocular MG Activities of Daily Living (MG-ADL) score over 24 months, analyzed using a linear mixed-effects model. Results: Baseline ocular MG-ADL scores were higher in the HMP group (mean ± standard deviation, 4.842 ± 1.642 vs. 3.353 ± 1.057). The mixed-effects model demonstrated a significant group-by-time interaction ( p < 0.001). At 1 month, the least-squares mean ocular MG-ADL score was 0.474 (95% confidence interval [CI], 0.024–0.923) in the HMP group and 2.000 (95% CI, 1.525–2.475) in the OCS group, with a significant between-group difference after Tukey adjustment ( p < 0.001). From 3 months onward, scores remained low in both groups without significant between-group differences. The HMP group achieved minimal symptom expression earlier. Oral prednisolone doses and prednisolone-related adverse events did not differ significantly between groups. Initial worsening occurred in two HMP-treated patients, but neither developed myasthenic crisis. Conclusion: In persistent ocular MG, early HMP as part of induction immunotherapy was associated with faster ocular symptom improvement and earlier achievement of minimal symptom expression than OCS induction alone, while long-term clinical outcomes and oral prednisolone doses were similar. Early HMP may be useful when rapid symptom control is required, although prospective studies are needed.
SN - 1664-2295
ER -