Tacrolimus alone is better tolerated than glucocorticoids alone in patients with mild to moderate myasthenia gravis (MG) while being as efficient, according to a new study published in the journal Annals of Clinical and Translational Neurology

Tacrolimus could therefore be a safe and effective initial immunotherapy for patients with mild to moderate disease who cannot be treated with glucocorticoids or refuse the treatment due to potential adverse effects.

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Tacrolimus is usually only used to treat mild to moderate MG cases that do not respond to glucocorticoids. 

Here, a team of researchers from China explored whether tacrolimus may have advantages over glucocorticoids in the treatment of mild to moderate MG. 

The researchers analyzed a total of 173 patients. Of these, 116 were treated with glucocorticoids, while 57 were treated with tacrolimus, 38 of them because glucocorticoids were contraindicated, and 19 because they refused it. 

The results of their analysis showed that there were no differences in the median time to minimal manifestations status or better between patients treated with glucocorticoids alone and those treated with tacrolimus alone.

(Minimal manifestation refers to no symptoms or functional limitations from MG but some weakness on examination of some muscles. A minimal manifestation status or better is recommended as the main component of the treatment goal in the international consensus guidelines for managing MG.)

There were also no differences between the 2 groups of patients in the median time to relapse. 

The changes in Myasthenia Gravis-specific Activities of Daily Living (MG-ADL), a scale that assesses the impact of MG on daily functions, were also similar between the 2 groups of patients. 

Notably, the rate of adverse events was lower in patients treated with tacrolimus alone compared to those treated with glucocorticoids alone.

The authors concluded that monotherapy with tacrolimus as initial immunotherapy could be an effective and safe regimen for patients with mild to moderate MG.


Fan Z, Lei L, Su S, et al. Comparison between mono-tacrolimus and mono-glucocorticoid in the treatment of myasthenia gravis. Ann Clin Transl Neurol. Published online February 20, 2023. doi:10.1002/acn3.51746