Prognosis After Discontinuation of Azathioprine or Mycophenolate Mofetil in Well-Controlled Myasthenia Gravis: A Retrospective Analysis
Muscle and Nerve, vol.73, no.2, pp.292-296, 2026 (SCI-Expanded, Scopus)
- Publication Type: Article / Article
- Volume: 73 Issue: 2
- Publication Date: 2026
- Doi Number: 10.1002/mus.70105
- Journal Name: Muscle and Nerve
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, CINAHL, EMBASE, MEDLINE
- Page Numbers: pp.292-296
- Keywords: azathioprine, discontinuation of AZA/MMF, immune suppressive treatment, myasthenia gravis, mycophenolate mofetil
- Dokuz Eylül University Affiliated: Yes
Abstract
Introduction/Aims: Azathioprine (AZA) and mycophenolate mofetil (MMF) are generally used for long periods when treating myasthenia gravis. In well-controlled patients, discontinuation of AZA/MMF may be a cause for concern because of the possibility of relapse. We aimed to evaluate relapse and relapse-related parameters after discontinuation of AZA/MMF. Method: Patients who had discontinued AZA or MMF monotherapy were retrospectively reviewed. We reviewed relapse, whether in pharmacological remission (PR) or exhibiting minimal manifestations (MM 1), disease duration, duration of AZA/MMF use, and other clinical parameters. Results: A total of 32 patients were included who either discontinued AZA (n = 28) or MMF (n = 4) treatments. Relapse was detected in 11 (34%). Patients in PR had fewer relapses than those with MM 1 (p = 0.023). Intravenous immunoglobulin was required in four. All patients who relapsed were stabilized with AZA/MMF. No significant association was found between relapse and age of disease onset, duration of disease, duration of AZA/MMF use, thymectomy status, or maximum Myasthenia Gravis Foundation of America score during active disease. Discussion: The results of this study suggest that patients in PR are less likely to relapse compared to those in MM 1. In well-controlled MG patients, AZA/MMF may be discontinued.