What is the treatment for myasthenia gravis?

From the Guidelines

The treatment for myasthenia gravis involves several approaches tailored to the patient's symptoms and disease severity, with pyridostigmine bromide administered orally two to four times a day as the first line of treatment, and corticosteroids, immunosuppressive therapy, and thymectomy considered for patients with moderate to severe disease or specific indications. The management of myasthenia gravis requires a comprehensive approach, considering the patient's overall health and disease severity.

• Pyridostigmine bromide is typically the first-line treatment, administered orally two to four times a day, but about half of patients with strabismus-associated myasthenia show minimal response 1.
• Corticosteroids are effective in about 66% to 85% of patients, and various forms of immunosuppressive therapy with azathioprine, and other agents under current investigation, such as efgartigimod alfa-fcab, may be offered by treating neurologists 1.
• Thymectomy is indicated in some cases, always in the presence of thymoma, and may substantially reduce symptoms for certain subpopulations with myasthenia gravis 1.
• For patients with moderate to severe disease, immunosuppressive therapy, including corticosteroids, azathioprine, mycophenolate mofetil, or cyclosporine, may be necessary, and rituximab may be used for refractory cases 1.
• Patients should avoid certain medications that can worsen symptoms, including some antibiotics, beta-blockers, and magnesium, and regular monitoring for medication side effects and disease progression is essential, with treatment adjustments made accordingly 1. The most recent and highest quality study recommends pyridostigmine bromide as the first line of treatment, and considers corticosteroids, immunosuppressive therapy, and thymectomy for patients with moderate to severe disease or specific indications 1.

From the FDA Drug Label

Pyridostigmine bromide is useful in the treatment of myasthenia gravis. Myasthenia gravis is a condition that can be treated with pyridostigmine bromide.

• The treatment for myasthenia gravis includes the use of pyridostigmine (PO), as indicated in the drug label 2.
• Pyridostigmine is used to manage the symptoms of myasthenia gravis.

From the Research

What is Myasthenia Gravis

• Myasthenia gravis (MG) is an autoimmune disease caused by antibodies against the acetylcholine receptor (AChR), muscle-specific kinase (MuSK), or other AChR-related proteins in the postsynaptic muscle membrane 3.
• It is characterized by localized or general muscle weakness, which is induced by the antibodies 3.
• The disease can be caused by various factors, including infections, stress, surgeries, thymus gland anomalies, and pharmaceutical side effects 4.

Symptoms of Myasthenia Gravis

• Ocular symptoms are initially experienced by most sufferers, and the majority of sufferers will go through at least one episode of symptom exacerbation during their illness 4.
• The immune system in MG interferes with nerve-muscle communication, causing muscles to become weak and tired quickly 4.
• The disease can affect various muscle groups, including ocular, bulbar, respiratory, axial, and limb muscles 4.

Treatment of Myasthenia Gravis

• Therapies for MG include symptomatic and immunosuppressive/immunomodulatory treatment 5.
• Options for immunosuppression include corticosteroids, azathioprine, mycophenolate mofetil, cyclosporine, tacrolimus, methotrexate, rituximab, cyclophosphamide, eculizumab, intravenous immunoglobulin, subcutaneous immunoglobulin, plasmapheresis, and thymectomy 5.
• Acetylcholinesterase inhibitors, such as pyridostigmine, are commonly used for symptomatic treatment, but can have side effects such as flatulence, urinary urgency, muscle cramps, blurred vision, and hyperhidrosis 6.
• Intravenous immunoglobulin or plasmapheresis can be used for disease exacerbations, and intensive care is necessary during exacerbations with respiratory failure 3.
• Continuous intravenous infusion of pyridostigmine or neostigmine can be a substitute for intravenous immunoglobulin or plasmapheresis if these are not available during crisis, but caution should be observed due to possible complications 7.