Azathioprine vs. Methotrexate Effectiveness in the Treatment of Generalized Myasthenia Gravis (MG)


  • Sadaf Iftikhar Department of Neurology, King Edward Medical University (KEMU), Mayo Hospital, Lahore, Pakistan
  • Asfand Kousar Department of Neurology, King Edward Medical University (KEMU), Mayo Hospital, Lahore, Pakistan
  • Aysha Ghayyur Department of Medicine, Allama Iqbal Medical College (AIMC), Jinnah Hospital, Lahore, Pakistan
  • Saman Shahid Department of Sciences & Humanities, National University of Computer & Emerging Sciences (NUCES), FAST Lahore Campus, Lahore, Pakistan
  • Adina Qaiser Department of Physiology, Khawaja Safdar Medical College, Sialkot Pakistan



: Azathioprine, Methotrexate, Generalized Myasthenia Gravis, Myasthenia Gravis Foundation of America (MGFA)


Objective: The current study investigated the effectiveness of Azathioprine versus Methotrexate in the treatment of generalized MG.

Methodology: An observational, open-label retrospective study was conducted in the Department of Neurology, Mayo Hospital, Lahore, Pakistan. All generalized MG patients with positive acetylcholine receptor antibodies (MGFA class II, III, or IV) aged >16 years, were included. Group 1 (n=31) was taking the combination of oral Prednisolone and Azathioprine (AZA) and group 2 (n=31) was taking the combination of Prednisolone and Methotrexate (MTX). The clinical response was assessed by Myasthenia gravis activities of daily living (MG-ADL) score at the 3rd, 6th, 9th, 12th, & 18th months.

Results: At 3rd month follow-up, the mean MG-ADL score was 2.97 (AZA) vs. 3.39 (MTX), after the 6th month, the score was 0.48(AZA) vs. 1.13 (MTX) (p-value=0.009), after the 9th month: the score was 0.26 (AZA), vs. 0.97(MTX) (p-value=0.002), after the 12th month, the score was 0.29 (AZA) vs. 0.74 (MTX) (p-value=0.079), after 15th month, the score was 0.16(AZA) vs. 0.65(MTX) (p-value=0.009) and after 18th month, the score was 0.42(AZA) vs. 0.52(MTX) (p-value=0.703).

Conclusion: Azathioprine is significantly more efficacious from the 6th, 9th, 12th and after the 15th-month follow-up as compared to Methotrexate in the treatment of MG; however, on the 18th-month follow-up, both steroid-sparing drugs were equally effective. There appears to be no difference in the effectiveness of Azathioprine versus Methotrexate in the treatment of generalized MG.


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