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Analysis of change in anti‐acetylcholine receptor antibody and effect on myasthenia gravis symptoms by adjusting tacrolimus dosage according to the blood concentration
Author(s) -
Yokota Keisuke,
Fujii Yoshitaka,
Shitara Masayuki,
Hikosaka Yu,
Okuda Katsuhiro,
Moriyama Satoru,
Sasaki Hidefumi,
Yano Motoki
Publication year - 2015
Publication title -
neurology and clinical neuroscience
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.125
0ISSN - 2049-4173
DOI - 10.1111/ncn3.12001
Subject(s) - tacrolimus , myasthenia gravis , medicine , antibody , gastroenterology , antibody titer , acetylcholine receptor , pharmacology , immunology , titer , receptor , transplantation
Background Since its introduction, tacrolimus has been widely used in myasthenia gravis ( MG ) patients. However, the correlation between the blood concentration level of the drug, the change in anti‐acetylcholine receptor ( AC hR) antibody and the effect of the drug has not been reported. Aim We sought to evaluate the correlation between the dose of tacrolimus and the blood concentration, change in anti‐ AC hR antibody, and the effect on MG symptoms. Methods We retrospectively analyzed the data of 28 patients who were treated with tacrolimus. Steroid dose was not changed during the tacrolimus treatment. Change in the dose and the blood concentration of tacrolimus, the level of anti‐ AC hR antibody, and Myasthenia Gravis Foundation of America Clinical Classification were analyzed. Results The anti‐ AC hR antibody level decreased in 19 patients (19/26; 73%). There was a positive correlation between the dosage of tacrolimus and the blood concentration at the latest observation. The mean antibody level was reduced from 153.4 ± 278.2 nmol/L to 83.2 ± 148.7 nmol/L, ( P = 0.013). Regarding the Myasthenia Gravis Foundation of America Clinical Classification, the score improved in 22 patients (22/28; 79%). There was a significant positive correlation between the change in the anti‐ AC hR antibody titers and the change in Myasthenia Gravis Foundation of America Clinical Classification. Conclusion Tacrolimus is useful for treatment of MG patients. However, because the blood level of the drug at the same dosage varies among patients, a careful adjustment of the dose according to the blood concentration is necessary.