Trial reportBMC neurology2011
A single-blinded trial of methotrexate versus azathioprine as steroid-sparing agents in generalized myasthenia gravis.
Trial report in BMC neurology, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it, 117 citations in OpenAlex.
- Incidence and determinants of anxiety and depression in childhood-onset systemic lupus erythematosus: a systematic review and meta-analysis of proportion.Advances in rheumatology (London, England) · 2026Pooled it
- Methotrexate in generalized myasthenia gravis: a systematic review.Acta neurologica Belgica · 2023Pooled it
- A Randomized Open-Labeled Trial of Methotrexate as a Steroid-Sparing Agent for Patients With Generalized Myasthenia Gravis.Frontiers in immunology · 2022Trial
- Infection risk in sarcoidosis patients treated with methotrexate compared to azathioprine: A retrospective 'target trial' emulated with Swedish real-world data.Respirology (Carlton, Vic.) · 2021Trial
- A randomized controlled trial of methotrexate for patients with generalized myasthenia gravis.Neurology · 2016Trial
- Phase II trial of methotrexate in myasthenia gravis.Annals of the New York Academy of Sciences · 2012Trial
- Oral Corticosteroid and Nonsteroidal Immunosuppressant Therapy Use in Patients with Myasthenia Gravis Receiving Ravulizumab, Eculizumab, or Efgartigimod in the USA.Neurology and therapy · 2026Article
- Guideline for the management of myasthenic syndromes.Therapeutic advances in neurological disorders · 2023Review
- Pharmacotherapy of Generalized Myasthenia Gravis with Special Emphasis on Newer Biologicals.Drugs · 2022Review
- The Epidemiology and Phenotypes of Ocular Manifestations in Childhood and Juvenile Myasthenia Gravis: A Review.Frontiers in neurology · 2022Review
- Long-Term Efficacy of Non-steroid Immunosuppressive Agents in Anti-Muscle-Specific Kinase Positive Myasthenia Gravis Patients: A Prospective Study.Frontiers in neurology · 2022Article
- Post-Infectious Autoimmunity in the Central (CNS) and Peripheral (PNS) Nervous Systems: An African Perspective.Frontiers in immunology · 2022Review
- Adverse Side Effects Associated with Corticosteroid Therapy: A Study in 39 Patients with Generalized Myasthenia Gravis.Medical science monitor : international medical journal of experimental and clinical research · 2021Article
- Role of complement and potential of complement inhibitors in myasthenia gravis and neuromyelitis optica spectrum disorders: a brief review.Journal of neurology · 2021Review
- Review
- Overview of Dual-Acting Drug Methotrexate in Different Neurological Diseases, Autoimmune Pathologies and Cancers.International journal of molecular sciences · 2020Review
- Management Issues in Myasthenia Gravis Patients Living With HIV: A Case Series and Literature Review.Frontiers in neurology · 2020Article
- Management of Juvenile Myasthenia Gravis.Frontiers in neurology · 2020Review
- Reappraisal of Oral Steroid Therapy for Myasthenia Gravis.Frontiers in neurology · 2020Review
- Favorable Effects of Tacrolimus Monotherapy on Myasthenia Gravis Patients.Frontiers in neurology · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLong-term immunosuppression is often required in myasthenia gravis (MG). There are no published trials using methotrexate (MTX) in MG. The steroid-sparing efficacy of azathioprine (AZA) has been demonstrated after 18-months of starting therapy. However, AZA is considered expensive in Africa. We evaluated the steroid-sparing efficacy of MTX (17.5 mg weekly) compared with AZA (2.5 mg/kg daily) in subjects recently diagnosed with generalized MG by assessing their average monthly prednisone requirements.
methodsThe primary outcome was the average daily prednisone requirement by month between the two groups. Prednisone was given at the lowest dose to manage MG symptoms and adjusted as required according to protocol. Single-blinded assessments were performed 3-monthly for 2-years to determine the quantitative MG score and the MG activities of daily living score in order to determine those with minimal manifestations of MG.
resultsThirty-one subjects (AZA n = 15; MTX n = 16) satisfied the inclusion criteria but only 24 were randomized. Baseline characteristics were similar. There was no difference between the AZA- and MTX-groups in respect of prednisone dosing (apart from months 10 and 12), in quantitative MG Score improvement, proportions in sustained remission, frequencies of MG relapses, or adverse reactions and/or withdrawals. The MTX-group received lower prednisone doses between month 10 (p = 0.047) and month 12 (p = 0.039). At month 12 the prednisone dose per kilogram bodyweight in the MTX-group (0.15 mg/kg) was half that of the AZA-group (0.31 mg/kg)(p = 0.019).
conclusionsThis study provides evidence that in patients with generalized MG methotrexate is an effective steroid-sparing agent 10 months after treatment initiation. Our data suggests that in generalized MG methotrexate has similar efficacy and tolerability to azathioprine and may be the drug of choice in financially constrained health systems.
trial registrationSANCTR:DOH-27-0411-2436.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.