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Background: Myasthenia gravis (MG) is an autoimmune disorder that affects the neuromuscular junction of skeletal muscles. Main treatments consist of pharmacologic and surgical treatments, such as a thymectomy. Even when patients receive recommended therapy, many still suffer from weaknesses. There is very limited data available regarding clinical responses to treatment and longterm outcomes of MG. Objective: To study the long-term outcomes of clinical responses after thymectomies in patients with MG, as well as compare dosages of medication use before and after thymectomy and associating factors. Materials and Methods: Retrospectively reviewed 123 MG patients treated by pharmacological treatment and thymectomy between 1997 and 2011 in Srinagarind Hospital, Khon Kaen University. Endpoints included improvement of clinical symptoms during follow-up time and the response to therapy-defined categories such as complete stable remission (CSR), pharmacologic remission (PR), improved, stabilized or worsened. The average dosage of pharmacological treatment before and after the procedure and factors associated with satisfactory outcomes are also studied. Results: Among 123 patients, 94(75.8%) are females with a median age of 49.82 years (IQR 41.76 to 58.36) and average age of diagnosis of 37.45 years (27.51 to 45.33). The average period for thymectomy after diagnosis was 8.12 months (1.87 to 23.21). The surgical method of thymectomy is divided into transsternal and video-assisted thoracoscopic thymectomy, each with 115 and 8 patients respectively. The duration of follow-up was 36.18 months (19.82 to 76.9). Histological examination showed thymoma and non-thymoma were 20.32% and 79.68% respectively. In terms of overall response, 95.12% had a good response (CSR, PR, improved), while 4.88% had a poor response (stable, worse). 28 patients (22.76%) had CSR, 70 patients (56.91%) had PR and 19 patients (15.45%) had improvement of clinical symptoms. The disease had stabilized in 5 patients (4.07%), and 1 patient (0.81%) had worsening symptoms. Most of the patients required lower doses of pyridostigmine and prednisolone after surgery. Multivariate Cox regression analysis revealed that those with an age of diagnosis before 40 years old and lower dose of pyridostigmine use at 12 months after thymectomy showed significantly higher rates of CSR. Conclusion: Thymectomy along with pharmacologic therapy for MG patients showed satisfactory results in achieving remission and improving clinical response rates. Favorable factors for satisfactory outcome were age of diagnosis before 40 years old and lower dose of pyridostigmine use at 12 months after thymectomy. [ABSTRACT FROM AUTHOR]

We conducted a prospective multicenter, opened-label, parallel, randomized, controlled trial to compare tacrolimus (TAC) and mycophenolate mofetil (MMF) for induction and maintenance therapy in lupus nephritis (LN). Adult patients with biopsy-proven LN International Society of Nephrology/Renal Pathology Society classes III-V and active nephritis were to receive prednisolone (0.7-1.0 mg/kg/day for four weeks of run-in period and tapered) and randomly assigned to receive TAC (0.1 mg/kg/day) or MMF (1.5-2 g/day) as induction therapy for six months. All patients who had remission received azathioprine (AZA) 1-2 mg/kg/day as standard treatment in the maintenance phase. The primary outcome was Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2K) at six and 12 months, and the secondary outcomes included renal SLEDAI, non-renal SLEDAI, modified SLEDAI-2K, immunity SLEDAI, and disease activity remission. Eighty-four patients were randomized. One patient who was randomized to the TAC group withdrew from the study immediately after randomization. Therefore, 42 patients received MMF and 41 patients received TAC. Disease activity remission rate and time to disease activity remission were similar in both groups. Twelve patients (28.57%) in the MMF group and 10 patients (24.39%) in the TAC group achieved disease activity remission. For disease activity scores, both regimens significantly improved SLEDAI-2K during induction and maintenance therapy. Overall, SLEDAI-2K score in the MMF group decreased more compared with the TAC group. In the MMF group, mean SLEDAI-2K decreased from 11.6±4.8 to 6.3±3.9 after induction therapy and to 5.4±4.4 after maintenance therapy. In the TAC group, mean SLEDAI-2K decreased from 9.0±3.7 to 6.3±5.1 after induction therapy and to 7.1±5.4 after maintenance therapy. Renal SLEDAI and modified SLEDAI-2K showed a similar pattern with SLEDAI-2K. In non-renal SLEDAI and immunity SLEDAI, both regimens also resulted in decreased disease activity scores during the first two months. After that the scores were slightly increased. In the MMF group, the scores were still lower than baseline but in the TAC group were not. In conclusion, disease activity remission rate was similar in the MMF and TAC groups. For disease activity score as measured by SLEDAI-2K, TAC was comparable with MMF during induction but MMF was more effective on disease activity of active LN classes III and IV at 12 months, especially in the renal system. [ABSTRACT FROM AUTHOR]