From the FDA Drug Label
RYSTIGGO is indicated for the treatment of generalized myasthenia gravis (gMG) in adult patients who are anti-acetylcholine receptor (AChR) or anti-muscle-specific tyrosine kinase (MuSK) antibody positive. AZASAN is usually given on a daily basis. The medications that could be considered for the long-term management of Myasthenia Gravis in a patient no longer responding to Physostigmine are:
- D Rystiggo (rozanolixizumab) 1
- C Azathioprine 2
- B Methotrexate Note that the FDA label for Methotrexate does not explicitly mention Myasthenia Gravis, but it is sometimes used off-label for this condition. However, without direct information from the label, this answer is not fully supported by the provided text.
From the Research
For a patient with Myasthenia Gravis no longer responding to physostigmine, the most appropriate long-term management medications to consider are Azathioprine, Methotrexate, and Rozanolixizumab (Rystiggo). These medications can be used as alternatives or in addition to other treatments, depending on the patient's specific needs and response to therapy. The choice of medication depends on various factors, including the severity of the disease, patient comorbidities, and potential side effects of the medications.
- Azathioprine is a well-established immunosuppressant that has been shown to be effective in the long-term management of Myasthenia Gravis, with a response rate of 83% in one study 3.
- Methotrexate is another immunosuppressant that can be used in the treatment of Myasthenia Gravis, particularly in patients who are intolerant or unresponsive to azathioprine 4.
- Rozanolixizumab (Rystiggo) is a newer medication that has shown promise in the treatment of Myasthenia Gravis, with a mechanism of action that targets the autoimmune response underlying the disease. In contrast, low-dose naltrexone and glycopyrrolate are not typically used in the long-term management of Myasthenia Gravis, and their effectiveness in this context is not well established 5, 6, 4, 7.