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Background Steroids are widely used for myasthenia gravis (MG) with many potential adverse effects. Currently, it’s unclear whether certain individuals would benefit from earlier initiation of steroid-sparing agents to reduce steroid exposure.Methods Data on response to prednisolone was collected from 63 patients who were started on prednisolone for MG between March 2015-July 2020.Results 66.7% of patient were male, average age 64.1 years. Average time between diagnosis and steroid initiation was 7.4 months, with peak dose reached after an average of 8 months. The average peak dose of prednisolone was 37.6mg/day (range 5-95mg/day), with 53.9% of patients experiencing remission at peak dose. 13% had dose escalation limited by side effects.53.9% of patients experienced relapse on withdrawal of steroids, occurring at an average dose of 11.6mg/day. Compared to patients on a peak prednisolone dose of ≤40mg, patients with a peak dose >40mg were more likely to relapse on steroid withdrawal (73% (average dose 14.9mg/day) vs 47% (average dose 8.8mg/day)), and considerably more likely to require a steroid-sparing agent (83% vs 46%).Conclusion Earlier initiation of immunosuppressive therapy should be considered when MG patients require >40mg of prednisolone/day to induce remission. These findings may have implications for future MG guidelines.paul.campbell@doctors.org.uk