Reevaluating Prednisolone Use in Adults ≥ 70 years With Myasthenia Gravis: Insights From a Retrospective Cohort Study

Background Prednisolone (PSL) is widely used in the treatment of myasthenia gravis (MG); however, the risk of PSL-related adverse effects increases with age. This study aimed to investigate the efficacy of PSL in patients aged ≥ 70 years by comparing clinical outcomes between those treated with PSL and those who were not. Methods In this retrospective single-center cohort study, we evaluated 12 consecutive patients with MG aged ≥ 70 years: seven received PSL combined with a calcineurin inhibitor (CNI), and five received CNI alone. Least-squares (LS) mean changes from admission to discharge were analyzed for MG Activities of Daily Living (MG-ADL) and Quantitative MG (QMG) scores. One year after treatment initiation, we assessed the decrement rate of acetylcholine receptor antibody titers (DR-AChR Ab) using a mixed-model repeated-measures (MMRM) approach, with pre-treatment levels as the baseline. We also evaluated the cumulative incidence of achieving minimal manifestations (MM) status. Results The LS mean improvement in MG-ADL scores was significantly greater in the PSL + CNI group compared to the CNI-alone group, while changes in QMG scores did not reach statistical significance. No significant differences were observed in DR-AChR Ab titers or in Kaplan–Meier analyses of MM achievement between the two groups. Conclusions Although PSL showed initial efficacy in patients with MG aged ≥ 70 years, all patients in both groups achieved MM or better status at 1 year. While these findings are preliminary, they suggest that PSL-free immunotherapy may be a viable treatment option for older adults with MG, following appropriate initial treatment adjustments.