{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T05:13:56Z","timestamp":1778649236086,"version":"3.51.4"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Corticosteroids (steroids) are the first-line immunotherapy for myasthenia gravis (MG), but the optimal steroid dosing regimen and effects of discontinuation remain unclear. This study aimed to investigate the associations of steroid regimens and steroid withdrawal with relapse risk in patients on steroid monotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cohort study, based on a prospective registry, included MG patients who achieved minimal manifestations or better status for at least 6\u202fmonths with steroid monotherapy. The primary outcome was relapse. Group-based trajectory modeling (GBTM) identified steroid regimens, and Cox proportional hazards models with propensity score matching (PSM) assessed the association of regimens and steroid withdrawal with relapse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 209 patients followed for a median of 54.0\u202fmonths, 113 (54.1%) experienced relapses. GBTM identified three regimens reflecting baseline disease severity: \u201cHigh Start, Fast Taper\u201d (Regimen 1), \u201cModerate Start, Gradual Taper\u201d (Regimen 2), and \u201cLow Start, Slow Taper\u201d (Regimen 3). Compared to the high-risk Regimen 1, Regimen 2 (HR\u202f=\u202f0.27,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and Regimen 3 (HR\u202f=\u202f0.15,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) were associated with significantly lower relapse risks. A statistically determined cut-off analysis found that requiring a maximum induction dose &amp;gt;0.83\u202fmg\/kg to achieve MM or better status was a predictor of relapse (HR\u202f=\u202f1.54,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.033). Sixty-eight (32.5%) withdrew steroids, and PSM showed that steroid withdrawal significantly increased relapse risk versus low-dose maintenance (HR\u202f=\u202f1.64,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.009).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this steroid-responsive population, patients requiring a maximum induction dose &amp;gt; 0.83\u202fmg\/kg to achieve MM or better status have a significantly higher risk of future relapse. Steroid withdrawal is associated with a higher relapse risk compared to low-dose maintenance and should be approached with caution.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1792705","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T04:46:43Z","timestamp":1778647603000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of steroid regimens and withdrawal with relapse risk in myasthenia gravis: a real-world cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Yangyu","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingwen","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuzhou","family":"Guan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1038\/s41572-019-0079-y","article-title":"Myasthenia gravis, nature reviews","volume":"5","author":"Gilhus","year":"2019","journal-title":"Disease Primers"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1212\/WNL.0000000000002790","article-title":"International consensus guidance for management of myasthenia gravis: executive summary","volume":"87","author":"Sanders","year":"2016","journal-title":"Neurology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"116648","DOI":"10.1016\/j.jns.2019.116648","article-title":"Maintenance immunosuppression in myasthenia gravis, an update","volume":"410","author":"Morren","year":"2019","journal-title":"J Neurol Sci"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1038\/s41582-023-00916-w","article-title":"Myasthenia gravis: the changing treatment landscape in the era of molecular therapies","volume":"20","author":"Iorio","year":"2024","journal-title":"Nat Rev Neurol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1212\/wnl.0000000000011124","article-title":"International consensus guidance for management of myasthenia gravis","volume":"96","author":"Narayanaswami","year":"2021","journal-title":"Neurology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1056\/NEJMoa1602489","article-title":"Randomized trial of Thymectomy in myasthenia gravis","volume":"375","author":"Wolfe","year":"2016","journal-title":"N Engl J Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1016\/s1474-4422(18)30392-2","article-title":"MGTX study group, long-term effect of thymectomy plus prednisone versus prednisone alone in patients with non-thymomatous myasthenia gravis: 2-year extension of the MGTX randomised trial, the lancet","volume":"18","author":"Wolfe","year":"2019","journal-title":"Neurology"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"17562864231213240","DOI":"10.1177\/17562864231213240","article-title":"Guideline for the management of myasthenic syndromes","volume":"16","author":"Wiendl","year":"2023","journal-title":"Ther Adv Neurol Disord"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e16229","DOI":"10.1111\/ene.16229","article-title":"Generalized myasthenia gravis with acetylcholine receptor antibodies: a guidance for treatment","volume":"31","author":"Gilhus","year":"2024","journal-title":"Eur J Neurol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1056\/NEJM197401102900204","article-title":"Gradually increasing doses of prednisone in myasthenia gravis. 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