Azathioprine in myasthenia gravis

Azathioprine has been used as a single therapy, or in combination with prednisolone, in the treatment of myasthenia gravis.

The combination of azathioprine and prednisolone has become the most widely used drug treatment for severe myasthenia gravis.

• a randomised controlled trial comparing prednisolone plus azathioprine with prednisolone alone showed that the prednisolone dose required to maintain remission was lower with combination treatment, over 60% of patients not requiring prednisolone at three years (1)

Note that though azathioprine was the first steroid-sparing agent shown to be effective in myasthenia gravis in a randomised, controlled trial, more recent studies suggest that methotrexate, ciclosporin and mycophenolate mofetil may be suitable alternatives (2)

Reference:

1. Palace J, Newsom-Davis J, Lecky B (1998). A randomized double-blind trial of prednisolone alone or with azathioprine in myasthenia gravis. Neurology, 50, 1778-83.
2. Prescriber 2005; 16(6):39-47.