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The steroid-sparing agents usually used to treat myasthenia gravis (MG) have limitations that might be avoided by using the immunosuppressive agent methotrexate. To test the effect of methotrexate in MG, researchers randomized 50 patients at 19 centers to receive prednisone (as needed for symptoms, according to the treating clinician), plus either 20 mg of methotrexate or placebo, for 12 months.
The two groups did not differ in the primary outcome of area under the prednisone dose-time curve from months 4 to 12.
Comment
As with previous unsuccessful trials of mycophenolate mofetil, limitations in this study included the unanticipated beneficial effect of prednisone in the control group and variability in the outco…