Clinical Effect Evaluation Of Tacrolimus In P450CYP3A5GG Type Of Myasthenia Gravis

ObjectiveWith the appearance of tacrolimus which is a new immunosuppressive,and the development of pharmacogenomics in recent years, myasthenia gravisimmune suppression therapy become a hot spot once again.This study discussthe clinical effecacy for the low dose of tacrolimus in the treatment ofmyasthenia gravis by CYP3A5GG, comparing34patients，clinical scoringchanges before and after the treatment,and the change of acetycholine receptorantibody before and after the treatment, then checking their effective drugconcentration range in the blood.MethodsSelect the patients with myasthenia grais which were inneurologydepartment of Chinese people’s liberation army the second artillerygeneral hospital in July2010to December2011,and all of the patients were I/IIof Osserman points type,using RT-PCR to detect CYP3A5genotype, Choose34patients whose acetylcholine receptors antibody (AchRAb) are positive,CYP3A5genotypes are GG type, applicate small dose tacrolimus treatmentunder the circumstance that following the principles of voluntary participationand signed informed consent.From taking orally1mg/d up to3mg/d, every5to7days increase by0.5mg, and monitor liver, kidney function, blood routine.During the treatment,the clinical scores were observed weekly, serumacetylcholine receptor antibody (AchRAb) titers levels were measured beforeand after treatment,and the blood concentration were measured weekly. Results34patients were all completed treatment,in addition to4cases occurredliver function mild abnormal transiently, the rest of the patients did not happenobvious adverse reaction. As the treatment time extending, the clinical absolutescoring of the MG patients were declining（P＜0.05）,the clinical response ratereached97.1%(33／34), AchRAb is also decrease before treatmen（tP＜0.05）,when the relative scoring≥50%,the95%confidence interval of the bloodconcentration overall mean is[3.821，5.317]（ng/ml）.ConclusionsThe treatment of low dose of FK506on myasthenia gravis (MG) achievedrapid response and effective clinicalanesis,safty and effectivity and it reduce thelevels of AchRAb, thus deserving to be widely used in the clinic.