From the Guidelines
Pyridostigmine bromide administered orally two to four times a day is the first line of treatment for myasthenia gravis. However, it's essential to note that about half of patients with strabismus-associated myasthenia show minimal response to this treatment 1.
Alternative Treatment Options
- Corticosteroids have shown a positive response in about 66% to 85% of patients, making them a viable alternative or addition to pyridostigmine bromide 1.
- Immunosuppressive therapy with azathioprine or other agents like efgartigimod alfa-fcab may be offered by treating neurologists, especially for patients who test positive for the anti-acetylcholine receptor 1.
- Thymectomy is indicated in some cases, particularly in the presence of thymoma, and may substantially reduce symptoms for certain subpopulations with myasthenia gravis 1.
Considerations for Treatment
- Remission or stabilization of the disease is often possible after 2 to 3 years of treatment, at which point surgical intervention for strabismus may be considered if desired or if prism use is insufficient 1.
- Care should be taken in the use of anesthetic agents given any evidence of associated weakness of the respiratory muscles 1.
- Surgical management, with and without the use of adjustable sutures, has met with modest success in cases where there is a stabilized primary deviation, sometimes exacerbated by fatigue 1.
From the FDA Drug Label
Pyridostigmine bromide is useful in the treatment of myasthenia gravis. Pyridostigmine (PO) is used for the treatment of myasthenia gravis 2.
- The drug is indicated for this condition.
- Pyridostigmine is a treatment option for myasthenia gravis.
From the Research
Myasthenia Gravis Treatment Options
- Myasthenia gravis (MG) treatment includes symptomatic and immunosuppressive therapy, with options such as corticosteroids, azathioprine, mycophenolate mofetil, and thymectomy 3
- Treatment should be based on MG subgroup and includes symptomatic treatment using acetylcholinesterase inhibitors, thymectomy, and immunotherapy 4
- Intravenous immunoglobulin and plasma exchange are fast-acting treatments used for disease exacerbations, and intensive care is necessary during exacerbations with respiratory failure 4
Acetylcholinesterase Inhibitors in Myasthenic Crisis
- Current MG guidelines recommend intravenous immunoglobulin or plasmapheresis and discontinuation of pyridostigmine during myasthenic crisis 5
- However, acetylcholinesterase inhibitors such as pyridostigmine or neostigmine can be a substitute for intravenous immunoglobulin or plasmapheresis if these are not available during crisis 5
- Continuous intravenous infusion of pyridostigmine or neostigmine can improve outcome measures, but caution should be observed due to possible complications such as cardiac arrhythmia and pneumonia 5
Effectiveness and Side Effects of Pyridostigmine
- Pyridostigmine is the most commonly used drug in the symptomatic treatment of MG, with a reported median effectiveness of 60 and net benefit of 65 6
- However, side effects are common, with 91% of patients currently using pyridostigmine reporting side effects, including flatulence, urinary urgency, muscle cramps, blurred vision, and hyperhidrosis 6
- Side effects were the reason for discontinuation of pyridostigmine in 26% of patients who discontinued the drug 6
Current Treatment of Myasthenia Gravis
- Substantial progress has been made in the treatment of MG, resulting in a change of its natural course from a disease with poor prognosis to a treatable condition with a large proportion of patients attaining very good disease control 7
- Current treatment options for MG include non-immunosuppressive and immunosuppressive treatments, as well as thymectomy and targeted immunomodulatory drugs 7