Fast Five Quiz: Refresh and Test Your Knowledge of Myasthenia Gravis

Amy Kao, MD

Disclosures

July 06, 2021

In the mild form of the disease, acetylcholinesterase inhibitors are commonly used initially. These agents include oral pyridostigmine and neostigmine. Pyridostigmine is used for maintenance therapy most often.

Although there is no consensus single treatment paradigm, MG is a treatable neurologic disorder. Several factors (eg, severity, distribution, rapidity of disease progression) should be considered before therapy is initiated or changed. Treatment regimens are individualized depending on the severity of disease, patient age, serology status, thymic pathology, concurrent medical issues, patient and physician preference, and physician experience.

For example, corticosteroids are the initial immunosuppressive therapy in ocular MG. Nonsteroidal immunosuppressive therapies (ie, AZA, MMF) are used alone (or first-line) only in cases when corticosteroids are contraindicated or declined by the patient, as these medications typically have a delayed clinical benefit on the order of months. A nonsteroidal immunosuppressive agent should be initially used in conjunction with corticosteroids especially when the long-term risk for steroid side effects is high on the basis of medical comorbidities. A nonsteroidal immunosuppressive agent is typically added to corticosteroids when the steroid side effects are deemed significant by the patient or the treating physician; when an adequate trial of corticosteroids has failed; or the corticosteroid dose cannot be reduced owing to symptom relapse. Other targeted immunotherapies are also emerging as options in the treatment of MG, especially for those individuals for whom standard agents have failed.

Learn more about the treatment of MG.

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