{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:58:22Z","timestamp":1791910702157,"version":"4.3.4"},"reference-count":37,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["62171299"],"award-info":[{"award-number":["62171299"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["CNS Neurosci Ther"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To identify factors influencing remission and relapse, and to evaluate the safety of tacrolimus monotherapy (TAMO) in adult\u2010onset mild\u2010to\u2010moderate myasthenia gravis (MG).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective analysis was conducted on MG patients receiving TAMO. Remission was defined as achieving minimal symptom expression (MSE), and multivariable Cox regression analysis identified predictors of remission and relapse. Cancer risk was assessed by standardized incidence ratio (SIR), based on the age\u2010specific cancer incidence rates in China in 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 153 patients, 77.8% achieved MSE, with a median time of 6.0\u2009months. Age at onset (hazard ratio [HR]\u2009=\u20090.982, 95% confidence interval [CI]\u2009=\u20090.968\u20130.995,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009) and new\u2010onset MG (HR\u2009=\u20092.065, 95% CI\u2009=\u20091.266\u20133.368,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004) were independent predictors of time to achieving MSE. The optimal cut\u2010off value for age at onset was 70\u2009years. Relapse occurred in 31% of patients. Tacrolimus concentration at MSE (HR\u2009=\u20090.815, 95% CI\u2009=\u20090.695\u20130.956,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012) and dose reduction speed (HR\u2009=\u20091.717, 95% CI\u2009=\u20091.280\u20132.305,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) were independent predictors of relapse. The cut\u2010off values were 5.30\u2009ng\/mL and 1.08\u2009mg\/year, respectively. Adverse drug reactions (ADRs) occurred in 45.0% of the 200 patients receiving TAMO, with hyperglycemia being the most common (17.5%). Eight patients developed cancer, and the SIR was 2.86 (95% CI\u2009=\u20091.23\u20135.63,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005) compared with the general Chinese population.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>TAMO was associated with higher rates of MSE in adult\u2010onset mild\u2010to\u2010moderate MG patients with new\u2010onset disease or with an onset age \u2264\u200970\u2009years. To avoid MG relapse, tacrolimus concentration &gt;\u20095.30\u2009ng\/mL at MSE and dose reduction speed \u2264\u20091.08\u2009mg\/year can be considered. Cancer surveillance may be considered for elderly patients undergoing long\u2010term tacrolimus therapy. Limitations include the retrospective, uncontrolled design, moderate sample sizes, and limited follow\u2010up duration; thus, long\u2010term safety, particularly cancer risk, requires further validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cns.70921","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T13:46:24Z","timestamp":1780321584000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Tacrolimus as Single\u2010Agent Immunotherapy for Adult\u2010Onset Myasthenia Gravis: Remission, Relapse, and Safety"],"prefix":"10.1002","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5748-6329","authenticated-orcid":false,"given":"Zhangyan","family":"Geng","sequence":"first","affiliation":[{"name":"Department of Neurology The First Hospital of Hebei Medical University  Shijiazhuang Hebei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuting","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Neurology Xuanwu Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4616-2861","authenticated-orcid":false,"given":"Nairong","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Neurology Xuanwu Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjia","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Neurology Xuanwu Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology Xuanwu Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0505-3243","authenticated-orcid":false,"given":"Yaye","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology Xuanwu Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoran","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology Xuanwu Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1271-862X","authenticated-orcid":false,"given":"Qinyao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology Xuanwu Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Congwen","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Neurology Xuanwu Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Neurology Xuanwu Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Neurology Xuanwu Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Di","sequence":"additional","affiliation":[{"name":"Department of Neurology Xuanwu Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology Xuanwu Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurology Xuanwu Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7260-2248","authenticated-orcid":false,"given":"Xinmei","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Neurology Xuanwu Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingchuan","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Neurology The First Hospital of Hebei Medical University  Shijiazhuang Hebei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuwei","family":"Da","sequence":"additional","affiliation":[{"name":"Department of Neurology The First Hospital of Hebei Medical University  Shijiazhuang Hebei China"},{"name":"Department of Neurology Xuanwu Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1602678"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2022.996213"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s42466-020-00091-z"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.594152"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.51746"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000098887.24618.A0"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000003350"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)00145-3"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.50.6.1778"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000312374.95186.cc"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2019.116648"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmd.2021.02.010"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/9138548"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/20406223221122538"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14039"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-020-09770-y"},{"issue":"7","key":"e_1_2_13_18_1","first-page":"721","article-title":"Chinese Guidelines for Diagnosis and Treatment of Myasthenia Gravis (2025 Edition)","volume":"58","author":"Neuroimmunology Branch of the Chinese Society of I","year":"2025","journal-title":"Chinese Journal of Neuroimmunology and Neurology"},{"issue":"6","key":"e_1_2_13_19_1","first-page":"613","article-title":"Long\u2010Term Safety and Effectiveness of Tacrolimus in Patients With Lupus Nephritis in Japan: 10\u2010Year Analysis of the Real\u2010World TRUST Study","volume":"51","author":"Takeuchi T.","year":"2024","journal-title":"Journal of Rheumatology"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2022.2887"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002790"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.13189"},{"issue":"3","key":"e_1_2_13_23_1","first-page":"221","article-title":"Cancer Incidence and Mortality in China, 2022","volume":"46","author":"Zheng R. S.","year":"2024","journal-title":"Zhonghua Zhong Liu Za Zhi"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13544"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.21462"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/17562864241309793"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.843523"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/17562864231214315"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/cns.13468"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14730"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1159\/000347068"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-016-2769-5"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.15687"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.17021"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-024-03285-x"},{"key":"e_1_2_13_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13833"},{"key":"e_1_2_13_37_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.140533"},{"key":"e_1_2_13_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2011.03621.x"}],"container-title":["CNS Neuroscience &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cns.70921","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cns.70921","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cns.70921","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T14:03:47Z","timestamp":1784124227000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cns.70921"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":37,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/cns.70921"],"URL":"https:\/\/doi.org\/10.1002\/cns.70921","archive":["Portico"],"relation":{},"ISSN":["1755-5930","1755-5949"],"issn-type":[{"value":"1755-5930","type":"print"},{"value":"1755-5949","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2025-05-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70921"}}