What are the treatment options for Myasthenia Gravis (MG)?

From the Guidelines

Pyridostigmine bromide administered orally two to four times a day is the first line of treatment for myasthenia gravis, but about half of patients with strabismus-associated myasthenia show minimal response. The treatment options for Myasthenia Gravis (MG) are multifaceted and depend on the severity of symptoms and the presence of thymoma.

• First-line treatment: Pyridostigmine bromide, as stated in the study 1, is the initial treatment approach, but its effectiveness varies among patients, particularly those with strabismus-associated myasthenia.
• Immunomodulatory therapy: For patients who do not respond adequately to pyridostigmine or have moderate to severe symptoms, corticosteroids are a viable option, with approximately 66% to 85% of patients showing a positive response, as noted in the study 1.
• Immunosuppressive therapy: Agents like azathioprine are known to be effective and may be offered to patients, along with other investigational agents such as efgartigimod alfa-fcab, which has recently been FDA approved for patients testing positive for the anti-acetylcholine receptor 1.
• Surgical intervention: Thymectomy is indicated in cases with thymoma and may be considered for certain subpopulations without thymoma, potentially leading to substantial symptom reduction, as mentioned in the study 1.
• Management of strabismus: Diplopia and strabismus management can be challenging and may require surgical intervention after disease stabilization, which can occur after 2 to 3 years of treatment, as indicated in the study 1.
• Anesthetic considerations: Care should be taken when using anesthetic agents due to potential respiratory muscle weakness associated with MG, highlighting the need for cautious management in surgical cases, as noted in the study 1.

From the FDA Drug Label

Pyridostigmine bromide is useful in the treatment of myasthenia gravis. The treatment options for Myasthenia Gravis (MG) include pyridostigmine.

• Pyridostigmine (PO) is a treatment option for MG 2

From the Research

Treatment Options for Myasthenia Gravis (MG)

The treatment options for Myasthenia Gravis (MG) include:

• Symptomatic treatment with pyridostigmine 3
• Immunosuppressive treatment with:
  • Corticosteroids (e.g. prednisolone, prednisone) 3, 4, 5, 6, 7
  • Azathioprine 3, 4, 5, 6, 7
  • Mycophenolate mofetil 3, 4, 5, 6, 7
  • Cyclosporine 4, 5, 6, 7
  • Tacrolimus 4
  • Methotrexate 4, 5
  • Rituximab 4, 5
  • Cyclophosphamide 4, 5, 6, 7
  • Eculizumab 4
• Immunomodulatory treatment with:
  • Intravenous immunoglobulin 3, 4, 5, 6, 7
  • Subcutaneous immunoglobulin 4
  • Plasmapheresis 3, 4, 5, 6, 7
• Thymectomy 3, 4, 5, 6, 7

Disease-Specific Treatment Options

The treatment options may vary depending on the disease subtype and severity:

• Nonthymomatous ocular MG: prednisolone is often effective 3
• Thymoma: thymectomy is indicated 3
• Acetylcholine receptor antibody-positive patients with generalized weakness developing under the age of 45 years: thymectomy is an option 3
• Older patients and those failing to respond to thymectomy: prednisone alone or combined with azathioprine is the treatment of choice 3
• Patients intolerant of azathioprine: mycophenolate mofetil is an option 3