[Treatment of myasthenia: role of corticoids and immunosuppressive agents].
OPTIMAL TREATMENT: Myasthenia is an autoimmune disease related to a recognized autoantigen. Treatment is aimed at providing symptomatic relief or a pathophysiological effect. The latter approach, with corticosteroid and immunosuppressor regimens, has proven to be effective, improving functional improvement, but at the cost of prolonged treatment over several years with the risk of major adverse effects. Indications and treatment modalities must be carefully weighed.
The question is when to start corticosteroids or immunosuppressors. A regimen should be initiated when, after all aggravating factors have been eliminated, a well-conducted anticholinesterase treatment remains ineffective with persistent major muscular deficit and brain stem disorders (deglutition, ventilation). Corticosteroids and immunosuppressors are also indicated if acute episodes occur, even if they regress.
To date, no controlled study has validated any particular therapeutic protocol. Both corticosteroids and immunosuppressors are known to provide major improvement in 80% of patients. No one immunosuppressor has been found to be more effective, but azathioprine is prescribed preferentially because of its lower profile of adverse effects.


CONCLUSIONS
Response is relatively rapid to corticosteroids which are recommended in combination with azathioprine at treatment onset for more severe cases (brain stem signs or recurrent acute episodes) or secondarily in case of resistance to moderate dose corticosteroids. In all cases, treatment must be prolonged for several years. Relapses are frequent after treatment withdrawal.
Gajdos
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D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001379:Azathioprine / Q000008:administration & dosage / Q000627:therapeutic use; D003524:Cyclosporins / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D009157:Myasthenia Gravis / Q000188:drug therapy*; D010919:Placebos; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D003524:Cyclosporins; D007166:Immunosuppressive Agents; D010919:Placebos; D001379:Azathioprine; D011241:Prednisone