{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T20:18:46Z","timestamp":1780604326027,"version":"3.54.1"},"reference-count":30,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2020,10,26]],"date-time":"2020-10-26T00:00:00Z","timestamp":1603670400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81601019"],"award-info":[{"award-number":["81601019"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["91642205"],"award-info":[{"award-number":["91642205"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81830038"],"award-info":[{"award-number":["81830038"]}],"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":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>To compare long\u2010term efficacy and safety of immunotherapeutic strategies as maintenance to prevent disease relapses of generalized myasthenia gravis (MG) in real\u2010world settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective cohort study on generalized MG conducted in seven major neurological centers across China. Eligible participants were patients with generalized MG who were under minimal manifestation status or better. Main outcome measures were probability of patients free of relapses and causes of drug discontinuation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 1064 patients enrolled, the median (interquartile range) age was 50.3 (37.0\u201062.5) years and 641 (60.2%) were women. Disease relapse was significantly lower for rituximab (6.1%) compared with all the other monotherapies (hazard ratio [HR]\u00a0=\u00a00.18, 95% confidence interval [CI] 0.06 to 0.56, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.0030). As combination therapies, tacrolimus in combination with corticosteroids reduced risk of disease relapses compared with azathioprine with corticosteroids (HR\u00a0=\u00a00.45, 95% CI 0.25 to 0.81, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.0077) or mycophenolate mofetil with corticosteroids (HR\u00a0=\u00a00.32, 95% CI 0.15 to 0.67, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.0020). Otherwise, lower\u2010dose corticosteroids or azathioprine as monotherapy significantly increased risk of disease relapses (HR\u00a0=\u00a02.78, 95% CI 1.94 to 3.99, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.0001; HR\u00a0=\u00a02.14, 95% CI 1.42 to 3.23, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.0003, respectively). The proportion of discontinuation was lowest in patients with rituximab (20.4%) as monotherapy and tacrolimus with corticosteroids (23.6%). Overall, combination treatment of immunosuppressants with corticosteroids had a lower rate of discontinuation compared with corresponding monotherapy (HR\u00a0=\u00a00.51, 95% CI 0.36 to 0.71, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Rituximab as monotherapy and tacrolimus with corticosteroids displayed better clinical efficacy as well as drug maintenance to prevent disease relapses in patients with generalized MG.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cns.13468","type":"journal-article","created":{"date-parts":[[2020,10,26]],"date-time":"2020-10-26T08:47:23Z","timestamp":1603702043000},"page":"1241-1254","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Immunotherapy choice and maintenance for generalized myasthenia gravis in China"],"prefix":"10.1111","volume":"26","author":[{"given":"Chao","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Neurology Tianjin Neurological Institute Tianjin Medical University General Hospital Tianjin Medical University  Tianjin China"},{"name":"National Clinical Research Center for Neurological Diseases of China Jing\u2010Jin Center for Neuroinflammation Beijing Tiantan Hospital Capital Medical University  Beijing China"},{"name":"Department of Neurology Beijing Tiantan Hospital Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bitao","family":"Bu","sequence":"additional","affiliation":[{"name":"Department of Neurology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurology Xiangya Hospital Central South University  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2782-4010","authenticated-orcid":false,"given":"Lihua","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology The Second Affiliated Hospital Harbin Medical University  Harbin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weibin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology National Key Clinical Department and Key Discipline of Neurology The First Affiliated Hospital Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui\u2010Sheng","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Neurology The First Affiliated Hospital of Shandong First Medical University  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meini","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology The First Hospital of Shanxi Medical University  Taiyuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei","family":"Zeng","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Neurological Diseases of China Jing\u2010Jin Center for Neuroinflammation Beijing Tiantan Hospital Capital Medical University  Beijing China"},{"name":"Department of Neurology Beijing Tiantan Hospital Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Du","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Neurological Diseases of China Jing\u2010Jin Center for Neuroinflammation Beijing Tiantan Hospital Capital Medical University  Beijing China"},{"name":"Department of Neurology Beijing Tiantan Hospital Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Yang","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Neurological Diseases of China Jing\u2010Jin Center for Neuroinflammation Beijing Tiantan Hospital Capital Medical University  Beijing China"},{"name":"Department of Neurology Beijing Tiantan Hospital Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9675-4637","authenticated-orcid":false,"given":"Fu\u2010Dong","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Neurology Tianjin Neurological Institute Tianjin Medical University General Hospital Tianjin Medical University  Tianjin China"},{"name":"National Clinical Research Center for Neurological Diseases of China Jing\u2010Jin Center for Neuroinflammation Beijing Tiantan Hospital Capital Medical University  Beijing China"},{"name":"Department of Neurology Beijing Tiantan Hospital Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,26]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1602678"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13311-015-0398-y"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/14737175.2017.1241144"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2016.4190"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.314"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneuroim.2017.05.021"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2018-319410"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2019.116648"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/cns.13110"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-018-0110-z"},{"key":"e_1_2_10_12_1","first-page":"CD002828","article-title":"Corticosteroids for myasthenia gravis","author":"Schneider\u2010Gold C","year":"2005","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182a1aac7"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.23330"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002790"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.55.1.16"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410170304"},{"issue":"2","key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1053\/j.semtcvs.2019.09.002","article-title":"Risk factors for the exacerbation of myasthenic symptoms after surgical therapy for myasthenia gravis and thymoma","volume":"32","author":"Kato T","year":"2019","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"e_1_2_10_19_1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s12883-017-0857-7","article-title":"Clinical predictors for the prognosis of myasthenia gravis","volume":"17","author":"Wang L","year":"2017","journal-title":"BMC Neurol"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.26876"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.50.6.1778"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000312373.67493.7f"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1196\/annals.1405.000"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2011-300148"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14039"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-019-09191-6"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.25597"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000005323"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmd.2017.03.007"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.1301555"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000007600"}],"container-title":["CNS Neuroscience &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cns.13468","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/cns.13468","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cns.13468","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T02:13:15Z","timestamp":1693879995000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cns.13468"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,26]]},"references-count":30,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1111\/cns.13468"],"URL":"https:\/\/doi.org\/10.1111\/cns.13468","archive":["Portico"],"relation":{},"ISSN":["1755-5930","1755-5949"],"issn-type":[{"value":"1755-5930","type":"print"},{"value":"1755-5949","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,26]]},"assertion":[{"value":"2020-09-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-09-21","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-26","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}