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Treatment strategies for myasthenia gravis.
Expert Opin Pharmacother. 2009 May 15
Díaz-Manera J, Rojas-García R, Illa I.
Universitat
Autònoma Barcelona, Hospital Santa Creu i Sant Pau, Neuromuscular
Diseases Unit, Neurology Department, Av. Sant Antoni Maria Claret 167,
08025 Barcelona, Spain +34 93 556 5986 ; +34 93 556 5602 ;
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
.
Advances in the treatment of myasthenia
gravis (MG) have reduced mortality rates due to the disease and
improved patients' quality of life. Nowadays, attending neurologists
can choose among different treatment strategies for MG patients. An
exhaustive revision of published data on the efficacy of the different
therapeutic options for MG indicates that there are insufficient
evidence-based results. However, recommendations based on expert
opinion can be provided.
Thymectomy is indicated in all patients with a
thymoma or for generalized acetylcholine receptor-seropositive patients
aged 18 - 55 years. Steroids are the most widely used immunosuppressive
drug for MG. They are recommended as the first-line drug in all
patients with generalized MG without response to thymectomy, or in
those patients who do not fulfill criteria for the surgery. The
selection of second-line drugs may vary between protocols. We recommend
to start with azathioprine if insufficient remission is achieved with
steroids, followed by ciclosporin, mycophenolate and others. We use
rituximab or cyclophosphamide only in severely drug-resistant patients.
Finally, we recommend intravenous immunoglobulins or plasma exchange in
MG crisis, or for unstable patients before thymectomy or in clinical
exacerbations.
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