From the Guidelines
Medications for myasthenia gravis should include pyridostigmine bromide as the first-line treatment, with corticosteroids and immunosuppressive therapy such as azathioprine considered for patients with inadequate response or more severe disease. The treatment approach for myasthenia gravis involves a combination of medications aimed at increasing acetylcholine availability at neuromuscular junctions and suppressing the abnormal immune response that attacks acetylcholine receptors.
First-Line Treatment
- Pyridostigmine bromide is administered orally two to four times a day, as indicated in the most recent study 1.
Additional Therapies
- Corticosteroids, such as prednisone, are effective in about 66% to 85% of patients, according to 1 and 1.
- Immunossuppressive therapy with azathioprine is known to be effective and may be offered by treating neurologists, as stated in 1 and 1.
- Efgartigimod alfa-fcab, recently FDA approved for patients who test positive for the anti-acetylcholine receptor, may be considered for some patients, as mentioned in 1.
Important Considerations
- Thymectomy is indicated in some cases, particularly in the presence of thymoma, and may substantially reduce symptoms for certain subpopulations with myasthenia gravis, as noted in 1 and 1.
- Care should be taken when using anesthetic agents in patients with associated weakness of the respiratory muscles, as cautioned in 1 and 1.
- Surgical management for strabismus may be considered after 2 to 3 years of treatment if the disease is stabilized and prism use is insufficient, according to 1 and 1.
From the FDA Drug Label
Pyridostigmine bromide is useful in the treatment of myasthenia gravis. The medications for myasthenia gravis (MG) include pyridostigmine 2.
- Pyridostigmine is used in the treatment of myasthenia gravis.
From the Research
Medications for Myasthenia Gravis
The following medications are used to treat myasthenia gravis:
- Acetylcholinesterase inhibitors, such as pyridostigmine, which provide temporary, symptomatic treatment for all forms of myasthenia gravis 3, 4, 5
- Immune modulators, including:
- Corticosteroids, which are effective for long-term immune modulation in myasthenia gravis 3, 6, 7
- Azathioprine, which is used as a first-line treatment and as a steroid-sparing agent 3, 6, 7
- Mycophenolate mofetil, which is used as a first-line treatment and as a steroid-sparing agent 3, 6, 7
- Cyclosporine, which is used as a first-line treatment and as a steroid-sparing agent 3, 6, 7
- Tacrolimus, which is used as an immunosuppressive treatment 6, 7
- Methotrexate, which is used as an immunosuppressive treatment 6, 7
- Rituximab, which is used as an immunosuppressive treatment 6, 7
- Cyclophosphamide, which is used as an immunosuppressive treatment 6, 7
- Eculizumab, which is used as an immunosuppressive treatment 6
- Other treatments, including:
- Intravenous immunoglobulin, which is used to achieve rapid improvement in patients with myasthenic crisis or exacerbation 3, 6, 7
- Plasmapheresis, which is used to achieve rapid improvement in patients with myasthenic crisis or exacerbation 3, 6, 7
- Thymectomy, which is used to increase the probability of myasthenic remission or improvement 3, 6, 7
Side Effects of Medications
The side effects of pyridostigmine, a commonly used acetylcholinesterase inhibitor, include: