Assosiasjon mellom bruk av prednisolon og selvrapportert livskvalitet hos norske myasthenia gravis-pasienter

Abstract

INTRODUCTION Better understanding and knowledge about the basic mechanisms of neuromuscular transmission and autoimmunity has lead to a development in treatment-strategies for myasthenia gravis (MG). Today the prognoses for these patients are good and the mortality low, but the quality of life (QOL) remains lower than expected. Results from two Japanese studies from 2012 and 2014 indicate that the amount of prednisolon used in the treatment is an important predictor for reduced QOL. The aim of this study was to se if we could find the same results within a Norwegian MG-population, and see if the total amount of prednisolon given to the patients during the case-story is associated with reduced quality of life. METHODS The study is a retrospective cross-sectional study including all MG-patients at Oslo Universitetssykehus (OUS) with available medical-record and who also had answered a QOL-questionnaire (SF-36) in 2010. 91 patients were included in the study, and 51 of these patients had been treated with prednisolon for their myasthenia. The remaining 41 patients were used as controls. Clinical data like medical side effects, type of treatment and drug dosages were registered from the medical records available in DIPS (OUS´ medical record-system). RESULTS After controlling for confounding factors, the results show no significant difference in mean mental composite score (MCS) (p=0,890) or mean physical composite score (PCS) (p=0,335) between the “prednisolon-group” and the controls. Nor the comparison between the patients using prednisolon at the time of study start (01.01.2010) and the patients using prednisolon earlier in their case story shows significant difference in QOL, occurrence of side-effects or cushingoid symptoms. Multivariate regression revealed that disease severity, prednisolon dosage of 15 mg/day, cushingoid symptoms, glaucoma and osteoporosis were predictors for reduced PCS, and disease severity and weight gain were predictors for reduced MCS. CONCLUSIONS This retrospective cross-sectional study among Norwegian myasthenia gravis-patients shows no association between use and dosage of prednisolon and the patient’s self-reported quality of life. The results of this study indicate that prednisolon has no direct influence on MG-patients quality of life. It seems more important to focus on clinical factors like occurrence of side effects and disease severity to increase the quality of life in this patient group.