Advanced Search

Journal of Traditional Chinese Medicine >

2022 , Vol. 42 >Issue 5: 810 - 817

DOI: https://doi.org/10.19852/j.cnki.jtcm.20220719.004

Research 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

  • Caifeng SHAN ,
  • Jingsheng ZHANG ,
  • Yi LIN ,
  • Xueshi HUANG ,
  • Zhanyou WANG ,
  • Haiou PAN ,
  • Wenjun QIAO
Expand
  • 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
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;

Received date: 2022-01-03

  Accepted date: 2022-06-06

  Online published: 2022-07-19

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)

Fold

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

Cite this article

Caifeng SHAN , Jingsheng ZHANG , Yi LIN , Xueshi HUANG , Zhanyou WANG , Haiou PAN , Wenjun QIAO . 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 . DOI: 10.19852/j.cnki.jtcm.20220719.004

References

1. Narayanaswami P, Sanders DB, Wolfe G, et al. International consensus guidance for management of myasthenia gravis: 2020 update. Neurology 2021; 96: 114-22.
2. Dresser L, Wlodarski R, Rezania K, Soliven B. Myasthenia gravis: epidemiology, pathophysiology and clinical manifestations. J Clin Med 2021; 10: 2235.
3. Bao WJ, Zhang JS, Qiao WJ. 73 cases of myasthenia gravis treated with Astragalus compound. Guang Ming Zhong Yi 2008; 23: 208-9.
4. Niu GH, Sun X, Zhang CM, Zhang JS. Effects of astragalus compound on lymphocyte subsets, immunoglobulin and complement in patients with myasthenia gravis. Zhong Xi Yi Jie He Za Zhi 2009; 29: 305-8.
5. Chang YT, Qiao WJ. Clinical observation of Compound Huangqi in the treatment of myasthenia gravis. Bei Fang Yao Xue 2016; 13: 31-2.
6. Chinese society of Traditional Chinese Medicine. Guide to diagnosis and treatment of common diseases in internal medicine of traditional Chinese Medicine. Beijing: China Traditional Chinese Medicine Publishing House, 2008: 7.
7. Branch of NeuroImmunization of Chinese Society of Immunology. Chinese guidelines for the Diagnosis and Treatment of myasthenia gravis (2020 Edition). Zhong Guo Shen Jing Mian Yi Xue He Shen Jing Bing Xue Za Zhi 2021; 28: 1-12.
8. Xu XH, Hou SF, Yin J. Acquired autoimmune myasthenia gravis. Zhong Guo Shen Jing Mian Yi Xue He Shen Jing Bing Xue Za Zhi 2012; 19: 409-12.
9. Drachman DB, Jones RJ, Brodsky RA. Treatment of refractory myasthenia: "rebooting" with high-dose cyclophosphamide. Ann Neurol 2003; 53: 29-34.
10. Pascuzzi RM, Coslett HB, Johns TR. Long-term corticosteroid treatment of myasthenia gravis: report of 116 patients. Ann Neurol 1984; 15: 291-8.
11. Chen X. Effect of glucocorticoid combined with cyclophosphamide on myasthenia gravis. Zhong Guo Dang Dai Yi Yao 2019; 26: 106-9.
12. Song YZ. Evaluation of observation and effective rate of tacrolimus in the treatment of patients with myasthenia gravis. Heilongjiang Yi Xue 2020; 44: 940-1.
13. Itani K, Nakamura M, Wate R, et al. Efficacy and safety of tacrolimus as long-term monotherapy for myasthenia gravis. Neuromuscul Disord 2021; 31: 512-8.
14. Ahn SW, Joo IS, Kim BJ, et al. A multicenter prospective observational study on the safety and efficacy of tacrolimus in patients with myasthenia gravis. Neurol Sci 2017; 379: 271-5.
15. Lee I, Kaminski HJ, McPherson T, et al. Gender differences in prednisone adverse effects: Survey result from the MG registry. Neurol Neuroimmunol Neuroinflamm 2018; 5: e507.
16. Bruce BB, Kupersmith MJ. Safety of prednisone for ocular myasthenia gravis. J Neuroophthalmol 2012; 32: 212-5.
17. Zhang T, Zhu GF. Clinical study on the treatment of glucocorticoid + cyclophosphamide with severe myasthenia gravis. Lin Chuang Yi Yao Wen Xian Za Zhi 2019; 6: 165.
18. Kim YH, Shin HY, Kim SM. Long-Term safety and efficacy of tacrolimus in myasthenia gravis. Yonsei Med J 2019; 60: 633-9.
19. Wang JM, Luo J, Xu Y, et al. Wang-Bi tablet, a patented Chinese medicine, maintains the balance of Th1/Th2 in mice with collagen-induced arthritis. J Tradit Chin Med 2020; 40: 401-6.
20. Lan TJ, Luo XF, Mo MY, et al. Hydrolyzed seawater pearl tablet modulates the immunity via attenuating Th1/Th2 imbalance in an immunosuppressed mouse model. J Tradit Chin Med 2021; 41: 397-405.
21. Li S, Fu J, Yang D. Immunopathogenesis of myasthenia gravis. J Brain Nerv Dis 2018; 26: 790-2+9.
22. Gu D, Wogensen L, Calcutt NA, et al. Myasthenia gravis-like syndrome induced by expression of interferon gamma in the neuromuscular junction. J Exp Med 1995; 181: 547-57.
23. Duan RS, Wang HB, Yang JS, Scallon B, Link H, Xiao BG. Anti-TNF-alpha antibodies suppress the development of experimental autoimmune myasthenia gravis. J Autoimmun 2002; 19: 169-74.
24. Gao L, Li ZL. Progress in the pathogenesis and clinical treatment of myasthenia gravis. Zhong Wai Yi Xue Yan Jiu 2019; 17: 173-6.
25. Dalakas MC. Immunotherapy in myasthenia gravis in the era of biologics. Nat Rev Neurol 2019; 15: 113-24.
26. Chen Z, Liu L, Gao C, et al. Astragali Radix (Huangqi): a promising edible immunomodulatory herbal medicine. J Ethnopharmacol 2020; 258: 112895.
27. Liu J, Wei J, Wang C, et al. The combination of Radix Astragali and Radix Angelicae Sinensis attenuates the IFN-γ-induced immune destruction of hematopoiesis in bone marrow cells. BMC Complement Altern Med 2019; 19: 356.
28. Rukeya G, Sun YJ, Zhong LZ, et al. Research progress on plant chemical constituents and biological activities of Lycium barbarum. Zhong Guo Shi Pin Xue Bao 2013; 13: 161-72.
29. Ye GY, Chen Y. Research progress on immunomodulatory effect and application of motherwort. Yi Xue Zong Shu 2011; 17: 2996-8.
30. Wang M, Wang YF, Duan PN, Zhao YR. Regulation mechanism of Atractylodes macrocephala polysaccharide on intestinal health and immune function and its application in livestock and poultry production. Dong Wu Ying Yang Xue Bao 2021; 33: 2428-38.
31. Qiao WJ, Cui YH, Kong JD, et al. Therapeutic effect of Compound Huangqi Granule on type I and type II myasthenia gravis with spleen and kidney deficiency. Liaoning Zhong Yi Za Zhi 2018; 45: 1360-3.
32. Liu P, Zhang JS, Han B, et al. Effect of Huangqi compound on expression of IFN-γ and mRNA in myasthenia gravis. Zhong Yi Yao Xue Kan 2004; 22: 2021-2.
33. Liu P, Zhang JS, Zheng F. The Regulating effects of Huangqi compound acetylcholine receptor antibody in patients with myasthenia gravis. Zhong Guo Shen Jing Mian Yi Xue He Shen Jing Bing Xue Za Zhi 2005; 76-8.
34. Wang S, Qiao WJ. Effect of Compound Huangqi decoction on the recurrence rate of type I and II myasthenia gravis. Ya Tai Chuan Tong Yi Yao 2018; 14: 175-6.
Options
Outlines

/

〈 〉