Effect of treatment with Fufang Huangqi decoction (复方黄杞汤剂) on dose reductions and discontinuation of pyridostigmine bromide tablets, prednisone, and tacrolimus in patients with type I or II myasthenia gravis

doi:10.19852/j.cnki.jtcm.20220719.004

Journal of Traditional Chinese Medicine ›› 2022, Vol. 42 ›› Issue (5): 810-817.DOI: 10.19852/j.cnki.jtcm.20220719.004

• Research Articles • Previous Articles Next Articles

Effect of treatment with Fufang Huangqi decoction (复方黄杞汤剂) on dose reductions and discontinuation of pyridostigmine bromide tablets, prednisone, and tacrolimus in patients with type I or II myasthenia gravis

SHAN Caifeng¹, ZHANG Jingsheng¹, LIN Yi², HUANG Xueshi³, WANG Zhanyou¹, PAN Haiou⁵(), QIAO Wenjun¹()

1 Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Liaoning Provincial Key Laboratory for Diagnosis and Treatment of Myasthenia Gravis, Liaoning University of Traditional Chinese Medicine, Shenyang 110033, China
2 Department of General Surgery, the First People's Hospital of Shenyang, Shenyang 110091, China
3 Institute of Microbial Pharmaceuticals, College of Life and Health Sciences, Northeastern University, Shenyang 110819, China
4 Institute of Health Sciences, Key Laboratory of Medical Cell Biology of Ministry of Education, China Medical University, Shenyang 110122, China
5 Liaoning University of Traditional Chinese Medicine, foreign language college, Liaoning University of Traditional Chinese Medicine, Shenyang 110033, China

Received:2022-01-03 Accepted:2022-06-06 Online:2022-10-15 Published:2022-07-19
Contact: PAN Haiou,QIAO Wenjun
About author:QIAO Wenjun, the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Liaoning Provincial Key Laboratory for Diagnosis and Treatment of Myasthenia Gravis, Liaoning University of Traditional Chinese Medicine, Shenyang 110033, China. qiaowj@lnutcm.edu.cn. Telephone: +86-24-31207261; 18102456736
PAN Haiou, Liaoning University of Traditional Chinese Medicine, Shenyang 110847, China. 30662238@qq.com;
Supported by:
Key R&D Program of Liaoning Province, China: Research on the Development of a New Chinese Medicine for the Treatment of Myasthenia Gravis(2020JH2/10300089);Construction Project of Liaoning Provincial Key Laboratory, China: Liaoning Provincial Key Laboratory for Diagnosis and Treatment of Myasthenia Gravis(2020JH13/10200022)

Abstract

Abstract:

OBJECTIVE: To investigate the clinical efficacy of Fufang Huangqi decoction (复方黄杞汤剂) in combination with pyridostigmine bromide tablets, prednisone, and tacrolimus in the treatment of type I and II myasthenia gravis (MG) through changes in the clinical symptom scores of 100 patients with type I and II MG. This study also aimed to examine dose reductions and dis-continuation of these 3 Western medicines after administration of Fufang Huangqi decoction.

METHODS: The clinical data on 100 patients with type I or II MG who were treated in the outpatient department of the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, China, between June 2017 and June 2020 were collected. The patients were divided into 4 groups based on whether they had taken pyridostigmine bromide tablets, prednisone, and/or tacrolimus at the time of their hospital visit: the Fufang Huangqi decoction group (group A), the pyridostigmine bromide tablets + Fufang Huangqi decoction group (group B), the pyridostigmine bromide tablets + prednisone + Fufang Huangqi decoction group (group C), and the pyridostigmine bromide tablets + tacrolimus + Fufang Huangqi decoction group (group D). The average treatment time was (15.6 ± 11.5) months (range: 0.5-55 months). Changes in the clinical symptom scores of the 4 groups of patients after medication administration and dose reductions and discontinuation of the 3 Western medicines were analyzed.

RESULTS: An overall effectiveness rate of 86.00% was achieved in the 100 patients after treatment for (15.6 ± 11.5) months (range 0.5-55 months). The effectiveness rates were 85.71% in group A, 88.24% in group B, 76.92% in group C, and 80.00% in group D. The dosage of pyridostigmine bromide was reduced for 69.12% of the patients in group B for the first time after (4.2 ± 4.1) months, and 45.59% of the patients in group B discontinued pyridostigmine bromide after (8.8 ± 6.1) months. The dosage of pyridostigmine bromide was reduced for 46.15% of the patients in group C for the first time after (5.3 ± 3.4) months, and 23.08% of the patients in group C discontinued pyridostigmine bromide after (19.8 ± 11.0) months; 76.92% reduced hormone dosage after (2.8 ± 1.9) months, and 23.08% discontinued hormone treatment after (6.7 ± 2.9) months. The dosage of pyridostigmine bromide was reduced for 1 patient in group D after 1 month; this patient discontinued pyridostigmine bromide after 3 months and reduced tacrolimus dosage after 5 months. One patient in group D discontinued pyridostigmine bromide and tacrolimus on his own initiative at 0.5 months and took Fufang Huangqi decoction for 2 months without discontinuing Western medicine.

CONCLUSION: Fufang Huangqi decoction is effective for the treatment of type I and II MG and improves the associated clinical symptoms. Moreover, this agent is conducive to dose reductions and discontinuation of basic Western medicines, thereby reducing the side effects experienced by patients.

Key words: myasthenia gravis, drug tapering, drug-related side effects and adverse reactions, Fufang Huangqi decoction

SHAN Caifeng, ZHANG Jingsheng, LIN Yi, HUANG Xueshi, WANG Zhanyou, PAN Haiou, QIAO Wenjun. Effect of treatment with Fufang Huangqi decoction (复方黄杞汤剂) on dose reductions and discontinuation of pyridostigmine bromide tablets, prednisone, and tacrolimus in patients with type I or II myasthenia gravis[J]. Journal of Traditional Chinese Medicine, 2022, 42(5): 810-817.

Figures/Tables 4

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Group	Osserman types (n)	Number of first reduction of bromopyrimidine tablets (n)	Time of first reduction of bromopyrimidine tablets (month)	Number of people who stopped bromopyrimidine tablets for the first time (n)	Time of stopping bromepyramine tablets for the first time (month)
B (n = 68)	I types (31)	21 (21/68)	3.6±3.5	17 (17/68)	8.4±5.9
	IIa types (13)	10 (10/68)	5.7±5.4	5 (5/68)	10.6±7.8
	IIb types (24)	16 (16/68)	4.2±4.0	9 (9/68)	8.6±6.3
C (n = 13)	I types (3)	2 (2/13)	3.0	1 (1/13)	2.5
	IIa types (4)	2 (2/13)	8.0	1 (1/13)	4.5
	IIb types (6)	2 (2/13)	5.0	1 (1/13)	30.0
D (n = 5)	I types (3)	1 (1/5)	1.0	1 (1/5)	3.0
	IIb types (2)	1 (1/5)	0.5	0 (0/5)	-

Group	Osserman types (n)	Number of first reduction of bromopyrimidine tablets (n)	Time of first reduction of bromopyrimidine tablets (month)	Number of people who stopped bromopyrimidine tablets for the first time (n)	Time of stopping bromepyramine tablets for the first time (month)
B (n = 68)	I types (31)	21 (21/68)	3.6±3.5	17 (17/68)	8.4±5.9
	IIa types (13)	10 (10/68)	5.7±5.4	5 (5/68)	10.6±7.8
	IIb types (24)	16 (16/68)	4.2±4.0	9 (9/68)	8.6±6.3
C (n = 13)	I types (3)	2 (2/13)	3.0	1 (1/13)	2.5
	IIa types (4)	2 (2/13)	8.0	1 (1/13)	4.5
	IIb types (6)	2 (2/13)	5.0	1 (1/13)	30.0
D (n = 5)	I types (3)	1 (1/5)	1.0	1 (1/5)	3.0
	IIb types (2)	1 (1/5)	0.5	0 (0/5)	-

Group	Osserman types (n)	Number of first prednisone reduction (n)	Time of first prednisone reduction (month)	Number of people stopping prednisone for the first time (n)	Time of first stopping prednisone (month)
C (n =13)	I types (3)	1 (1/13)	4.5	0(0/13)	-
	IIa types (4)	4 (4/13)	2.7±2.1	2(2/13)	3.7
	IIb types (6)	5 (5/13)	2.5±2.2	1 (1/13)	7.0

Group	Osserman types (n)	Number of first prednisone reduction (n)	Time of first prednisone reduction (month)	Number of people stopping prednisone for the first time (n)	Time of first stopping prednisone (month)
C (n =13)	I types (3)	1 (1/13)	4.5	0(0/13)	-
	IIa types (4)	4 (4/13)	2.7±2.1	2(2/13)	3.7
	IIb types (6)	5 (5/13)	2.5±2.2	1 (1/13)	7.0

Group	Osserman types (n)	Number of tacrolimus reduced for the first time (n)	Time of first reduction of tacrolimus (month)	Number of people stopping tacrolimus for the first time (n)	Time of first stopping tacrolimus (month)
D (n = 5)	I types (3)	1 (1/5)	5.0	1 (1/5)	6.0
	IIb types (2)	1 (1/5)	0.5	1(1/5)	0.5

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Effect of treatment with Fufang Huangqi decoction (复方黄杞汤剂) on dose reductions and discontinuation of pyridostigmine bromide tablets, prednisone, and tacrolimus in patients with type I or II myasthenia gravis

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References 34.

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Group	Osserman types (n)	Beter				Effective		Basic cure				Clinical cure
Group	Osserman types (n)	Number (n)		Time (month)	Number (n)		Time (month)		Number (n)	Time (month)			Number (n)		Time (month)
A (n = 14)	I types (8)	3 (3/14)	3.0±2.8			3 (3/14)	1.8±1.5	0 (0/14)			-	2 (2/14)		3.5
	IIa types (2)	0 (0/14)	-			0 (0/14)	-	0 (0/14)			-	0 (0/14)		-
	IIb types (4)	1 (1/14)	20.0			2 (2/14)	3.5	0 (0/14)			-	1 (1/14)		14.0
B (n = 68)	I types (31)	1 (1/68)	6.5			12 (12/68)	3.2±1.6	4 (4/68)			3.7±2.6	11 (11/68)		6.2±4.1
	IIa types (13)	4 (4/68)	5.1±4.1			6 (6/68)	7.6±5.9	0 (0/68)			-	0 (0/68)		-
	IIb types (24)	6 (6/68)	15.1±12.6			11 (11/68)	4.2±2.0	3 (3/68)			8.2±5.5	2 (2/68)		5.75
C (n = 13)	I types (3)	0 (0/13)	-			1	7.5	0 (0/13)			-	0 (0/13)		-
	IIa types (4)	0 (0/13)	-			0 (0/13)	-	2 (2/13)			3.0	2 (2/13)		16.0
	IIb types (6)	3 (3/13)	2.2±0.8			2 (2/13)	2.2	0 (0/13)			-	0 (0/13)		-
D (n = 5)	I types (3)	1 (1/5)	7.5			0 (0/5)	-	1 (1/5)			1.0	0 (0/5)		-
	IIb types (2)	0 (0/5)	-			1 (1/5)	7.5	0 (0/5)			4.0	0(0/5)		-

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