＜シンポジウム（2）―1―2＞重症筋無力症：臨床の問題点とその解決法
全身型MG治療の到達目標と副腎皮質ステロイド，カルシニューリンインヒビターの使用法
槍沢 公明1）, 長根 百合子1）, 鈴木 重明2）, 鈴木 則宏2）
1）総合花巻病院神経内科〔〒025―0075 岩手県花巻市花城町4―28〕
2）慶應義塾大学神経内科
The advent of effective immune treatment has meant that myasthenia gravis (MG) is most often not lethal. However, many MG patients still find it difficult to maintain daily activities due to chronic residual fatigability and long-term side effects of medication, since full remission without immune treatment is not common. Our analysis demonstrated that disease severity, dose of oral corticosteroids, and depressive state are the major independent factors negatively associated with self-reported QOL (MG-QOL15-J score). It is noteworthy that oral corticosteroid, the first-line agent for MG, is negatively associated with patients' QOL. When the analysis took into account MGFA postintervention status and dose of oral prednisolne (PSL), the MG-QOL15-J score of MM status patients taking ≤5 mg PSL per day is identically low (i.e., just as good QOL) as that seen in CSR and is a target of treatment. In order to veer away from high-dose oral corticosteroids and to achieve early MM or better status with PSL ≤5 mg/day, we advocate the early aggressive treatment strategy that can achieve early improvement by performing an aggressive therapy using combined treatment with plasmapheresis and high-dose intravenous methylprednisolone and then maintain an improved clinical status using low-dose oral corticosteroids and calcineurin inhibitors (cyclosporine microemulsion and tacrolimus). The early stages of MG are susceptible to treatment with calcineurin inhibitors. When using cyclosporine microemulsion for MG, blood concentrations 2 h after administration (C2) correlate with clinical improvement and immediately before administration (C0) with side effects (increased serum creatinine and/or hypertension). Monitoring of C2 and C0 levels is useful to estimate efficacy and safety of the drug.
Full Text of this Article in Japanese PDF (252K)
(臨床神経, 52：1047−1050, 2012)
key words：副腎皮質ステロイド，カルシニューリンインヒビター，生活クオリティー，重症筋無力症
（受付日：2012年5月24日）
