Myasthenia gravis medical therapy: Difference between revisions
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* glucocorticoids: There are many studies supporting the beneficial effect of [[glucocorticoids]] like oral [[prednisone]] and pulsed [[Intravenous|intravenous (IV)]] [[methylprednisolone]] in [[Myasthenia gravis|MG]] patients. This group of drugs can improve the [[Symptom|symptoms]] in almost 50 percent of patients.(6,7,8,11 chronic) the side effects of these drug are: Skin thinning and [[purpura]](13), [[Cushingoid appearance]] and weight gain(4), [[Cataract|cataracts]] and [[glaucoma]](7), [[ischemic heart disease]] and [[heart failure]](31), [[gastritis]], ulcer formation, and [[gastrointestinal bleeding]](48-49), [[Menstrual cycle|menstrual]] irregularities in women and low [[fertility]] in both men and women(66-67) and [[psychiatric]] and [[cognitive]] symptoms(71).(manabe az avareze korton) | * glucocorticoids: There are many studies supporting the beneficial effect of [[glucocorticoids]] like oral [[prednisone]] and pulsed [[Intravenous|intravenous (IV)]] [[methylprednisolone]] in [[Myasthenia gravis|MG]] patients. This group of drugs can improve the [[Symptom|symptoms]] in almost 50 percent of patients.(6,7,8,11 chronic) the side effects of these drug are: Skin thinning and [[purpura]](13), [[Cushingoid appearance]] and weight gain(4), [[Cataract|cataracts]] and [[glaucoma]](7), [[ischemic heart disease]] and [[heart failure]](31), [[gastritis]], ulcer formation, and [[gastrointestinal bleeding]](48-49), [[Menstrual cycle|menstrual]] irregularities in women and low [[fertility]] in both men and women(66-67) and [[psychiatric]] and [[cognitive]] symptoms(71).(manabe az avareze korton) | ||
* immunosuppressive drugs | * immunosuppressive drugs | ||
# Azathioprine: | # Azathioprine: [[Azathioprine]], a [[purine]] analogue which inhibits the [[Nucleic acid|nucleic acids]] synthesis, can cause improvement in about 90 percent of myasthenia gravis patients but the onset of this effect takes at least 6 to 12 month.(13-14-15-16 chronic) [[Azathioprine]] can cause [[macrocytosis]] (increased [[MCV]]) and [[Malignancy|malignancies]] such as [[Non hodgkin lymphoma|non-hodgkin lymphoma]]. (19-20 chronic) | ||
# Mycophenolate | # Mycophenolate: [[Mycophenolate]] mofetil, a [[purine]] synthesis blocker in [[Lymphocyte|lymphocytes]], is proven to be effective in reducing the [[Symptom|symptoms]] of [[Myasthenia gravis|MG]] patients and their need to [[glucocorticoids]].(25-26) | ||
# Cyclosporine | # Cyclosporine: [[Cyclosporine]], an immunomodulatory agent which blocks the production of [[Interleukin 2|interleukin-2]] and inhibits the function of [[T helper cell|T helper cells]], can cause improvement in about 90 percent of [[Myasthenia gravis|MG]] patients after 1 to 2 months of start but the maximum effect will appear after 7 months.(32-33-34 chronic) This drug can cause [[tremor]], [[nausea]], [[Myalgia|myalgias]], [[gingival hyperplasia]], [[hypertrichosis]] and [[Malignancy|malignancies]] such as [[squamous cell skin cancer]] and [[lymphoma]].(34) | ||
# Tacrolimus | # Tacrolimus | ||
# Rituximab | # Rituximab | ||
| Line 26: | Line 26: | ||
* plasmapheresis | * plasmapheresis | ||
* intravenous immune globulin | * intravenous immune globulin | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 14:04, 21 June 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
The mainstays of medical therapy for myasthenia gravis are:
Symptomatic treatments
An oral anticholinesterase like pyridostigmine is usually the first drug in MG patients.(5) these drugs can reduce the degradation of Ach in the synaptic cleft.(7) limbs and bulbar muscles respond very well to these drugs but ocular symptoms including diplopia are resistance to these medications.(8) (manabe az treatment)
Chronic immunomodulating treatments
- glucocorticoids: There are many studies supporting the beneficial effect of glucocorticoids like oral prednisone and pulsed intravenous (IV) methylprednisolone in MG patients. This group of drugs can improve the symptoms in almost 50 percent of patients.(6,7,8,11 chronic) the side effects of these drug are: Skin thinning and purpura(13), Cushingoid appearance and weight gain(4), cataracts and glaucoma(7), ischemic heart disease and heart failure(31), gastritis, ulcer formation, and gastrointestinal bleeding(48-49), menstrual irregularities in women and low fertility in both men and women(66-67) and psychiatric and cognitive symptoms(71).(manabe az avareze korton)
- immunosuppressive drugs
- Azathioprine: Azathioprine, a purine analogue which inhibits the nucleic acids synthesis, can cause improvement in about 90 percent of myasthenia gravis patients but the onset of this effect takes at least 6 to 12 month.(13-14-15-16 chronic) Azathioprine can cause macrocytosis (increased MCV) and malignancies such as non-hodgkin lymphoma. (19-20 chronic)
- Mycophenolate: Mycophenolate mofetil, a purine synthesis blocker in lymphocytes, is proven to be effective in reducing the symptoms of MG patients and their need to glucocorticoids.(25-26)
- Cyclosporine: Cyclosporine, an immunomodulatory agent which blocks the production of interleukin-2 and inhibits the function of T helper cells, can cause improvement in about 90 percent of MG patients after 1 to 2 months of start but the maximum effect will appear after 7 months.(32-33-34 chronic) This drug can cause tremor, nausea, myalgias, gingival hyperplasia, hypertrichosis and malignancies such as squamous cell skin cancer and lymphoma.(34)
- Tacrolimus
- Rituximab
- Methotrexate
- Etanercept
- Cyclophosphamide
Rapid immunomodulating treatments
- plasmapheresis
- intravenous immune globulin