Drug of choice for myasthenia gravis (PGI Nov 2012)
a. The mainstay of therapy is administration of a cholinesterase inhibitor (e.g., pyridostigmine).
b. Corticosteroids, immunosuppressive agents, intravenous immunoglobulin, or plasma pheresis are effective in patients with refractory disease.
Extra edge: (Ref. Hari- 18th ed., pg- 3484)
1). Mycophenolate mofetil has become one of the most widely used drugs in the treatment of MG because of its effectiveness and relative lack of side effects.
2. Azathioprine, the calcineurin inhibitors cyclosporine and tacrolimus (FK506) are also used.
3). Cyclophosphamide is reserved for occasional patients refractory to the other drugs (see above for discussion of high-dose cyclophosphamide treatment).
d. Sometime spontaneous remission can occur.
Thymic Abnormalities and myasthenia Gravis (MG) and recommendations for thymectomy
Myasthenia Gravis patients have a high incidence of thymic abnormalities Thymus is abnormal in about 75% of patients
65% of patients have a hyperplastic thymus
10% of patient have thymomas
Thymus is believed to play a role in the autoimmune dysfunction in M G and thymectomy has shown significant improvement in upto 85% of patients with MG (35% achieve drug free remission).