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What is the usual chronic course of patients treated with steroids?
Patients may be successfully tapered to very low doses over approximately 12 months in most cases, especially when thymectomy has been performed.
However, a significant minority of patients will experience an exacerbation (usually mild) as steroids are tapered below a certain point.
This is treated by slight, recurrent increases in dosage.
However, should a second attempt at steroid taper fail, the introduction of an adjunctive agent, such as azathioprine, is often necessary before taper can be successfully resumed.
Excessively rapid steroid tapers are responsible for many severe exacerbations in patients with Myasthenia gravis.
Sources
Richman DP, Agius MA: Treatment of autoimmune myasthenia gravis. Neurology 61:1652-1661, 2003.
