Safety of Prednisone for Ocular Myasthenia Gravis

Background: Treatment with chronic corticosteroids has been associated with frequent significant adverse effects. We hypothesized that a long-term low-dose prednisone regimen for ocular myasthenia gravis (OMG) would have a low rate of major side effects. Methods: Consecutive OMG patients from a single institution over a 16-year period and treated with >= 1 month of daily prednisone were included. Steroid-related complications were defined as the development/worsening of conditions requiring alteration to medical therapy. Serious complications included conditions requiring emergency care, hospitalization, or surgery. Results: Eighty-three patients with follow-up period ranging from 1 to 271 months (median, 58 months) were included. Fifty-eight (70%) patients had follow-up period of >= 24 months. The maximum prednisone dose ranged from 10 to 60 mg. Tapering to <= 10 mg/d required <= 4 months for all but 2 patients. Median average daily dose following the initial course was 5 mg daily (interquartile range, 4-7.5 mg). During the first 2 years, there were 24.5 complications per 100 person-years. Only one patient had a serious complication within the first 2 years (2-year cumulative risk, 1%), but this individual was not following the recommended regimen. Conclusions: Low-dose prednisone for OMG has an acceptable side-effect profile and causes few serious complications (2-year risk, similar to 1%). However, patients need monitoring to detect the relatively common, but less serious, complications (2-year risk, similar to 39%) to adjust medical therapy in a timely fashion.