From the Guidelines
Treatment for myasthenia gravis in a 93-year-old patient should prioritize minimizing symptoms and maximizing quality of life, with a focus on pharmacological management due to the patient's advanced age. The recommended approach is:
- Start with acetylcholinesterase inhibitors, specifically pyridostigmine (Mestinon), at a low dose of 30-60 mg three to four times daily, as it is the first line of treatment for myasthenia gravis 1.
- If symptoms persist, add immunosuppressive therapy, such as corticosteroids, which have shown a positive response in 66% to 85% of patients 1.
- Consider steroid-sparing agents like azathioprine, which is known to be effective, for long-term management 1.
- For patients who test positive for the anti-acetylcholine receptor, efgartigimod alfa-fcab, a recently FDA-approved treatment, may be offered by treating neurologists 1.
- Regular monitoring of respiratory function and swallowing ability is crucial, and counseling and referral to a neurologist or neuro-ophthalmologist may be indicated in the management of myasthenia 1.
- Thymectomy is generally not recommended for patients of this age unless there's a thymoma, due to the risks associated with surgery in elderly patients.
- Avoid medications that can worsen myasthenia gravis, such as certain antibiotics and beta-blockers, and be aware of any comorbidities, such as respiratory distress, that might present with generalization of the disease 1.
From the FDA Drug Label
Pyridostigmine bromide is useful in the treatment of myasthenia gravis.
The treatment option for Myasthenia Gravis (MG) in a 93-year-old patient is pyridostigmine (PO), as it is indicated for the treatment of myasthenia gravis 2.
From the Research
Treatment Options for Myasthenia Gravis (MG)
The treatment options for Myasthenia Gravis (MG) in a 93-year-old patient include:
- Oral acetylcholinesterase (AChE) inhibitors, such as pyridostigmine, for symptomatic treatment 3
- Immunotherapy, including corticosteroids and/or azathioprine, for long-term disease-modifying treatment 3
- Thymectomy, which may be considered in certain cases 4
Considerations for Older Adults
When treating older adults with MG, it is essential to consider the potential side effects of medications, such as pyridostigmine, which can include flatulence, urinary urgency, muscle cramps, blurred vision, and hyperhidrosis 5
- Low-dose medications may be effective in maintaining disease stability and minimizing side effects, with no significant difference in MG Foundation of America (MGFA) scores compared to conventional therapeutic dosing 6
Individualized Treatment Approach
Treatment for MG should be individualized according to disease severity, antibody status, comorbidities, and other factors 4
- A careful evaluation of the patient's myasthenic and cardiac status, as well as perioperative management, is crucial when considering surgical procedures, such as coronary artery bypass grafting 7