Myasthenia gravis (MG): non-steroid immunosuppression: agents

Evidence-based neurology checklist on myasthenia gravis (mg): non-steroid immunosuppression: agents: Azathioprine This is the first line non-steroid option It is administered if MPTP level is sufficient: this is the enzyme that metabolises Azathioprine The dose is built up over one month to…

Azathioprine

  • This is the first line non-steroid option
  • It is administered if MPTP level is sufficient: this is the enzyme that metabolises Azathioprine
  • The dose is built up over one month to 2.5mg/kg body weight daily
  • Weekly blood tests are required during dose titration
  • Also see Neurochecklist: “Azathioprine”

Methotrexate

Rituximab

Ciclosporin

Mycophenolate

Cyclophosphamide

Eculizumab

Ravulizumab

Efgartigimod

Rozanolixizumab

Zilucoplan

Recently approved agents

References

  1. Skeie GO, Apostolski S, Evoli A, et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol 2010; 17:893-902.
  2. Sanders DB, Wolfe GI, Benatar M, et al. International consensus guidance for management of myasthenia gravis: executive summary. Neurology 2016; 87:419-425.
  3. Sathasivam S. Steroids and immunosuppressant drugs in myasthenia gravis. Nat Clin Pract Neurol 2008; 4:317-327.
  4. Heckmann JM, Rawoot A, Bateman K, Renison R, Badri M. A single-blinded trial of methotrexate versus azathioprine as steroid-sparing agents in generalized myasthenia gravis. BMC Neurology 2011; 11:97.
  5. Prado MB Jr, Adiao KJB. Methotrexate in generalized myasthenia gravis: a systematic review. Acta Neurol Belg 2023 (Online ahead of print).
  6. And 10 more. Subscribe to see the full list

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