Tratamiento médico y quirúrgico de la miastenia ocular
Información
- DOI:
- https://doi.org/10.1002/14651858.CD005081.pub3Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 12 diciembre 2012see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Neuromuscular
- Copyright:
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- Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
Michael Benatar and Henry Kaminski both evaluated each paper and extracted the relevant data. Michael Benatar wrote the first draft of the review. Henry Kaminski commented on and edited the draft to produce a final review. In 2010 both authors assessed 'Risk of bias' in the included studies. Both authors reviewed searches for updates and approved the text.
Declarations of interest
Dr Michael Benatar is the principal investigator on a RCT designed to compare the efficacy of prednisone plus pyridostigmine versus placebo plus pyridostigmine for the treatment of ocular myasthenia. He receives research funding from both the US National Institutes of Health (NIH) and the Food and Drug Administration for clinical trials in the field of MG.
Henry Kaminski is co‐investigator of the NIH‐sponsored trial of thymectomy for treatment of non‐thymomatous MG. He serves as consultant for Varleigh Limited, which is developing a drug for treatment of MG. He has served as a consultant for GlaxoSmithKline and serves on the Data and Safety Monitoring Board for a clinical trial sponsored by Cytokinetics. He receives royalties from Springer Publishing. He has performed legal consultations in cases related to MG.
Acknowledgements
The authors are grateful to Kate Jewitt and Richard Hughes at the Cochrane Neuromuscular Disease Group for their advice during the preparation of this review. We are also grateful to the late John Newsom‐Davis, Tony Swan, Philippe Gajdos and Sumit Singh for their helpful comments on an earlier draft of this review.
The editorial base of the Cochrane Neuromuscular Disease Group is supported by the MRC Centre for Neuromuscular Diseases and the Muscular Dystrophy Campaign.
Version history
| Published | Title | Stage | Authors | Version |
| 2012 Dec 12 | Medical and surgical treatment for ocular myasthenia | Review | Michael Benatar, Henry Kaminski | |
| 2006 Apr 19 | Medical and surgical treatment for ocular myasthenia | Review | Michael Benatar, Henry Kaminski | |
| 2005 Jan 24 | Medical and surgical treatment for ocular myasthenia | Protocol | Michael Benatar, Henry Kaminski | |
Differences between protocol and review
For the 2010 update we revised the 'Risk of bias' methodology and stated outcomes that would be included in a 'Summary of findings' table. At the 2012 update, the RevMan categories for review authors 'Risk of bias' judgements changed (Higgins 2011).
The protocol gives details of methodology that the review authors would have followed had more data been available (Benatar 2006).
Notes
A published, completed study (Benatar 2016) has been added to Characteristics of studies awaiting classification, pending a planned full update of the review.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Humans;
PICO
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
| Author (year) | n | Study Design | Demographics | Treatment | Treatment Schedule | Confounding | Follow‐up | Blinding | OR (95% CI) |
| Papapetropoulos (2003) | 28 | Case‐control | Mean age 48.6 | Steroids | Gradual titration to 60 mg every other day and then tapered to lowest dose required (5 to 10 mg every other day) | Adequate | Adequate | Not done | 4.3 (0.6 to 25.9) |
| Mee (2003) | 34 | Case‐control | Mean age 55 | Steroids | 25 mg per day (mean duration of therapy 33.5 months) | Adequate | Adequate | Not done | 0.02 (0.001 to 0.16) |
| Kupersmith (2003) | 147 | Cohort | Mean age 50 | Steroids | 10 mg per day for 2 days, 20 mg per day for 2 days, dose increased to 50 to 60 mg per day for 4 to 5 days, 40 mg per day for 1 week, 30 mg per day for 1 week, 20 mg per day for 1 week, 10 mg/20 mg every alternate day for 1 week, dose further reduced by 2.5 mg per day each week | Adequate | Inadequate | Not done | 0.13 (0.04 to 0.45) |
| Monsul (2004) | 56 | Cohort | Mean age 53 | Steroids | 40 to 60 mg per day tapered to 2.5 to 10 mg per day over 3 to 6 months | Adequate | Adequate | Not done | 0.24 (0.06 to 0.99) |
| Sommer (1997) | 78 | Cohort | Mean age 50.6 | Steroids | Maximum dose 52 mg per day (mean duration of therapy 32 months) | Inadequate | Adequate | Not done | 0.09 (0.03 to 0.29) |
| Kupersmith (2009) | 87 55 prednisone 32 no prednisone | Cohort | Mean age | Steroids | 10 mg per day for 2 days, 20 mg per day for 2 days, dose increased to 50 to 60 mg per day for 7 days, dose decreased by 10mg per week to 10 mg per day, dose further reduced by 2.5 mg per day each week | Inadequate. Prednisone treated patients were those who did not refuse or had no contra‐indication to prednisone treatment. Gender distribution, age and frequency of elevated AChR antibodies were comparable between the two treatment groups. | Adequate | Not done | 0.15 (0.05 to 0.4) |
| Ortiz (2008) | 21 6 prednisone 15 no prednisone | Cohort | Median age 2.6 | Steroids | Not specified | Inadequate. No discussion of whether the two treatment groups were comparable with respect to important potential confounding variables. | Adequate | Not done | 1.3 (0.09 to 17.7) |
| Sommer (1997) | 78 | Cohort | Mean age 50.6 | Azathioprine | Maximum dose 145 mg per day (mean duration of therapy 44 months) | Inadequate | Adequate | Not done | 0.18 (0.05 to 0.67) |
| Kawaguchi (2005) | 75 | Cohort | Mean age 41 | Thymectomy | Adequate | Adequate | Not done | 0.23 (0.012 to 4.31) | |
| OR: odds ratios of development of generalized MG amongst those receiving active treatment compared to those receiving control treatment. | |||||||||
| Author (year) | n | Study Design | Demographics | Treatment | Confounding | Follow‐up | Blinding | OR (95% CI) |
| Bhanushali (2008) | 16 | Cohort | Median age 53.5 Range 30‐77 | Steroids | Inadequate. No discussion of whether the two treatment groups were comparable with respect to important potential confounding variables. | Adequate Follow‐up in 100% | Not done | 6.75 (0.93 to 49.2) |
| Ortiz (2008) | 21 | Cohort | Median age 2.6 Range 1.2 ‐ 4.9 | Steroids | Inadequate. No discussion of whether the two treatment groups were comparable with respect to important potential confounding variables. | Adequate Follow‐up in 100%; mean duration 6.5 (range 2‐15.6) | Not done | 0.8 (0.07 to 9.67) |
| Papatestas (1987) | 313 | Cohort | Not reported | Thymectomy | Not done | Adequate | Not done | 0.82 (0.18 to 3.8) |
| Kawaguchi (2005) | 75 17 thymectomy 58 no thymectomy | Cohort | Mean age 41 Range 1‐76 35% male | Thymectomy | Adequate | Adequate | Not done | 0.97 (0.27 to 3.45) |
| CI: confidence interval OR: odds ratios of improvement in ocular symptoms amongst those receiving active treatment compared to those receiving control treatment. | ||||||||
