Traditional treatments and different geographical approaches

Abstract

Therapies for myasthenia gravis (MG) include symptomatic and immunosuppressive/ immunomodulatory treatment. The application of one or more treatments should be based on known efficacy, particularly for specific disease subtypes, disease activity, adverse effect profile, and patient co-morbidities. Traditional treatments include symptomatic treatment and disease- modifying therapy, such as steroids, immunosuppressants, plasmapheresis, intravenous immunoglobulin and thymectomy. Most patients are started with pyridostigmine and steroids but depending on severity or specific type of MG the immunosuppressant or other therapy are added. There is some variability in current recommendations in different MG management guidelines (e.g. Japanese compared to North American), mainly in the selection of glucocorticoids and the first-line non-steroidal immunosuppressants. In this chapter we carry out a review and comparison of all these treatments and compare the different international and national guidelines and consensus, and regional approaches. Approvals of novel therapeutics in MG should not deter clinicians from looking at older interventions, as these still play a key role in the treatment of MG.

Keywords: Glucocorticoids; Immunosupressors; Myasthenia gravis; Pyridostigmine; Robotic thymectomy; Thymectomy; Thymoma; Videoscopic thymectomy.