Myasthenia Gravis
Conditions
Keywords
myasthenia gravis, leflunomide
Brief summary
This is a randomized controlled clinical study. The investigators screen of eligible patients, randomized divide into the following two groups: corticosteroids + azathioprine group, corticosteroids + leflunomide group. The investigators treat the enrolled patients, estimate efficacy and observed the side effects according to the requirements of program. The investigators establish a clinical database for recording patients date and statistical analysis. Evaluation of short-term and long-term efficacy of thymectomized myasthenia gravis patients in the different group prove that what kind of treatment can improve the cure rate. The investigators will evaluate the acute toxicity (gastrointestinal side effects, liver and kidney dysfunction) and long-term toxicity (immune dysfunction, gonadal suppression) when the investigators apply these therapy in the treatment of different clinical types of myasthenia gravis.
Interventions
DRUGAzathioprine
The basic therapy of each group is cholinesterase inhibitors (pyridostigmine 36mg / kg / d). Group 1 glucocorticoid + Azathioprine: Glucocorticoid (0.25mg/kg/d )plus Azathioprine at a starting dose of 50mg/d for 14 days, then increase up to 2mg/kg in 2 weeks.If no adverse events occurred , maintain the dose until 48 weeks.
DRUGLeflunomide
The basic therapy of each group is cholinesterase inhibitors (pyridostigmine 36mg / kg / d). Group 2 glucocorticoid + Leflunomide: Glucocorticoid (0.25mg/kg/d )plus Leflunomide 20mg/d for adult, 10mg/d for child. if no adverse events occurred , maintain the dose until 48 weeks.
Sponsors
First Affiliated Hospital, Sun Yat-Sen University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
12 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
1. 12 to 65 years； 2. Myasthenia gravis: 1. Patients who are diagnosed as generalized or ocular myasthenia gravis 2. have experienced extended thymectomy (including thymic hyperplasia and thymoma)， no significant complications in 6 months after operation , and does not received any immunosuppressants or glucocorticoids treatments. 3. do not applied in plasmapheresis or immunoglobulins treatment during 3 months . 4. women of child-bearing period do not have a plan of pregnant for at least 3 year. 5. Written consent of the patient, after informing
Exclusion criteria
1. The liver , kidney or glycometabolic function is abnormal 2. Seriously complications, such as infection or symptom in central nervous system, 3. The patients who suffering from malignancy or a history of malignancy, a variety of sexually transmitted diseases and HIV infection, tuberculosis infection, and other condition which need to prohibit the use of immunosuppressive patients. 4. Be allergic to leflunomide, azathioprine 5. Pregnant or suckling period woman 6. Accompanied with mental disorders and have difficult to communication 7. Experienced myasthenia crisis in 3 months. 8. suffering from clear cardiopulmonary functional and brain abnormalities 9. Have a history of refractory hypertension or peptic ulcer . 10. One of the white blood cells, hemoglobin, and platelet count obvious abnormalities
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| the percent of achieving good response | 144 weeks | Pharmacologic Remission (PR) was the primary efficacy endpoint observed. Record the time the patient appears from the time of medication to the time of PR, and calculate the percentage of PR patients in each arm. Criteria for PR: The patient has had no symptoms or signs of MG for at least 1 year and continues to take some form of therapy for MG. There is no weakness of any muscle on careful examination by someone skilled in the evaluation of neuromuscular disease. Isolated weakness of eyelid closure is accepted. Patients taking cholinesterase inhibitors are excluded from this category because their use suggests the presence of weakness. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The changes of the disease severity and the antibody titer during the follow-up | 144 weeks | The magnitude by which QMG or ADL scores are reduced. Total amount of steroid used during the follow-up. Level of the acetylcholine receptor antibody. |
Countries
China
Outcome results
None listed