{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:49:18Z","timestamp":1787014158496,"version":"build-2736575974"},"reference-count":15,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,8,8]],"date-time":"2019-08-08T00:00:00Z","timestamp":1565222400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003478","name":"Ministry of Health, Labour and Welfare","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background and purpose<\/jats:title>\n                    <jats:p>\n                      Tapering immunosuppressants is desirable in patients with well\u2010controlled myasthenia gravis (\n                      <jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content>\n                      ). However, the association between tapering of calcineurin inhibitor dosage and reduction\u2010associated exacerbation is not known. The aim of this study was to clarify the frequency of reduction\u2010associated exacerbation when tacrolimus is tapered in stable patients with anti\u2010acetylcholine receptor antibody\u2010positive\n                      <jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content>\n                      , and to determine the factors that predict exacerbations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed 115 patients in whom tacrolimus dosage was tapered. The reduction\u2010associated exacerbation was defined as the appearance or worsening of one or more\n                      <jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content>\n                      symptoms &lt;3\u00a0months after the reduction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Tacrolimus dosage was successfully tapered in 110 patients (96%) without any exacerbation. Five patients (4%) experienced an exacerbation, but symptoms were reversed in all patients when the tacrolimus dose was increased to the previous maintenance level. No patient developed an\n                      <jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content>\n                      crisis. The age at onset was significantly earlier (30 vs. 56\u00a0years,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.025) and the reduction in dosage was significantly larger (2.0 vs. 1.0\u00a0mg\/day,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.002) in patients with reduction\u2010associated exacerbation than in those without exacerbation. The cut\u2010off values determined in a receiver\u2010operating characteristic curve analysis were 52\u00a0years (sensitivity, 57%; specificity, 100%) for the age at onset and 1.5\u00a0mg (sensitivity, 80%; specificity, 100%) for the dose reduction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Tapering of tacrolimus was possible in most patients with well\u2010controlled anti\u2010acetylcholine receptor antibody\u2010positive\n                      <jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content>\n                      . Early age at onset and a large reduction from maintenance dosage were associated with exacerbation. Reductions \u22641.5\u00a0mg\/day from the maintenance dosage should be considered for patients with late\u2010onset disease.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ene.14039","type":"journal-article","created":{"date-parts":[[2019,7,15]],"date-time":"2019-07-15T21:53:25Z","timestamp":1563227605000},"page":"100-104","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Safety of tapering tacrolimus dose in patients with well\u2010controlled anti\u2010acetylcholine receptor antibody\u2010positive myasthenia gravis"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6158-9355","authenticated-orcid":false,"given":"Y.","family":"Nishida","sequence":"first","affiliation":[{"name":"Department of Neurology and Neurological Science Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3421-1212","authenticated-orcid":false,"given":"Y. 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