Clinical efficacy of tacrolimus in the treatment of ocular myasthenia gravis in the elderly
Objective To investigate the clinical efficacy of tacrolimus in the treatment of ocular myasthenia gravis(OMG)in the elderly.Methods A retrospective analysis was conducted on elderly patients with OMG diagnosed and treated in the Department of Neurology,Beijing Tongren Hospital,Capital Medical University from January 2020 to June 2023.Patients were divided into a glucocorticoid group and a tacrolimus group based on their medication regimen.The clinical efficacy and adverse drug reactions were compared between the two groups.Additionally,the effects of the combined use of wuzhi capsules on a daily dose of tacrolimus,blood concentration,and time to reach the target concentration were analyzed in CYP3A5 expressers in the tacrolimus group.Results A total of 75 patients were included,with 27 cases in the glucocorticoid group and 48 cases in the tacrolimus group.The average time to clinical remission in the glucocorticoid group was(10.6±1.7)weeks,which was shorter than that in the tacrolimus group was(16.6±1.5)weeks,but the difference was not statistically significant(P>0.05).The incidence of adverse drug reactions in the tacrolimus group was lower than that in the glucocorticoid group(8.3%vs 29.6%),with a statistically significant difference(P<0.05).Multivariate COX regression analysis showed that a pre-treatment QMG score>4(HR=0.203,95%CI:0.065 to 0.635,P=0.006),and anti-AChR antibody titer>3.9 nmol/L(HR=0.238,95%CI:0.084 to 0.677,P=0.007)were negatively correlated with achieving clinical remission.A tacrolimus blood concentration>6.2 ng/mL was positively correlated with achieving clinical remission(HR=2.697,95%CI:1.172 to 6.209,P=0.020).For CYP3A5 expressers,the daily dose of tacrolimus in the combined therapy group was lower than that in the monotherapy group[(1.7±0.5)mg vs(3.2±0.3)mg],and the time to first reach the target tacrolimus blood concentration was shorter than that in the monotherapy group[(1.7±0.4)weeks vs(3.3±0.5)weeks],and the differences were statistically significant(P<0.001).There was no significant difference in tacrolimus blood concentration between the two groups(P>0.05).Conclusion Tacrolimus is an effective treatment option for OMG in the elderly with fewer adverse reactions.It may be a safe and effective alternative for elderly patients who cannot tolerate glucocorticoids.
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