Fast Five Quiz: Refractory Myasthenia Gravis

Raghav Govindarajan, MD


October 13, 2021

In general, MG should be considered treatment refractory and an emergent therapy should be considered if the stepwise approach to MG therapy outlined in consensus guidelines does not prove effective, if treatment-associated side effects become intolerable or cause clinical deterioration, or if plasma exchange or intravenous immunoglobulin continue to be required on a chronic basis despite foundational therapy.

Although there is currently no agreed-upon definition, MG may be considered refractory with persistent moderate to severe weakness even with the application of conventional therapies (ie, maximal safe doses of steroids and at least one immunosuppressive drug at an adequate dose and duration). In addition, patients may be considered treatment refractory when showing severe or intolerable adverse effects from immunosuppressive therapy, or if they have comorbid conditions that restrict the use of conventional therapies; however they may be characterized as "treatment intolerant."

Learn more about the treatment of patients with MG.


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