[Actual aspects of myasthenia gravis treatment]
|Pol Merkuriusz Lek. 2003 Mar;14(81):256-60.|
[Article in Polish]
Czaplinski A, Radziwill AJ, Steck AJ.
Klinika Neurologii Uniwersytetu w Bazylei, Bazylea, Szwajcaria.
This paper reviews treatment strategies of myasthenia gravis (MG) that are currently in use: 1. enhancement of neuromuscular transmission with acetylcholinesterase inhibitors; 2. short-term immunotherapies, including plasma exchange and intravenous immunoglobulin therapy; 3. immunosuppression; 4. surgical thymectomy and thymomectomy. Acetylcholinesterase blockers are still used as the first-line treatment of MG. Although most of patients benefit from these drugs, the improvement is usually incomplete and often wanes after weeks or months of treatment. When clinical symptoms are not adequately controlled by anticholinesterase drugs, immunosuppressive therapy is suggested, but indications for treatment take into account age and clinical symptoms (ocular versus generalised myasthenia). Steroids are the most commonly used and most consistently effective immunosuppressive agents for MG treatment but they also have the highest incidence of potential side effects. The use of azathioprine, for monotherapy in initial immunosuppression treatment of MG is controversial. However, data are available, including a randomised trial, to support the use of azathioprine as an adjunctive drug with corticosteroids. Retrospective analyses of the treatment of MG have shown that cyclosporine is also effective but renal toxicity and hypertension are the major factors limiting its use. Mycophenolate mofetil appeared also to be effective as adjunctive therapy in the treatment of refractory and steroid-dependent MG. Intravenous immunotherapy (IVIg) is recommended as an adjunct in the management of MG exacerbations. According to new publications, there are no pronounced differences in the efficacy of IVIg treatment and plasma exchange. Thymomectomy is beneficial and should be considered for all patients with thymoma-associated MG. However, in cases with non-thymomatous autoimmune MG, thymectomy is recommended only for patients below age 55-60 and within the first 6-12 months of disease duration.
- Review, Academic