An update on treatments in myasthenia gravis

This month, we discuss three papers which publish the results of trials into potential treatment approaches to myasthenia gravis (MG). When treatment with cholinesterase inhibitors alone fails to control symptoms, treatment with steroids may be required, often at high doses which are often associated with adverse side effects both in the short and long term. All the studies explore treatments that may replace or reduce the need for steroids in MG and use the quantitative myasthenia gravis (QMG) score and prednisone dose requirement as primary or secondary outcomes. The first paper reports results of a randomised trial of routine thymectomy in non-thymomatous MG patients, the results of which may see this procedure incorporated into routine management of non-thymomatous MG. The second and third papers explore alternative steroid-sparing immunosuppressive agents. At present, the only medications shown to be effective in randomised placebo-controlled studies are azathioprine and cyclosporine, but both carry the risk of adverse reactions and have a requirement for close monitoring. The second study compares methotrexate and prednisone treatment to prednisone alone and the final study assesses effectiveness of leflunomide. All three studies represent a valuable addition to the literature on treatment of a condition that currently has limited alternatives to long-term immunosuppression with steroids, azathioprine, or cyclosporine