Therapeutic options in autoimmune myasthenia gravis.
Autoimmune myasthenia gravis (MG) is associated with circulating antibodies to AChR, modification of the synaptic cleft, and destruction of the postsynaptic neuromuscular membrane. The hallmark is fluctuating muscular weakness and fatigability of muscles on sustained repeated activity. Various drugs and invasive procedures have been used in the treatment of MG including acetylcholinesterase inhibitors, corticosteroids, azathioprine, cyclosporine, cyclophosphamide, mycophenolate mofetil, tacrolimus, etanercept, intravenous immunoglobulin, plasma exchange and thymectomy. We review the role of each of these drugs and invasive procedures in MG. Although current treatment is highly successful and mortality is almost nil, further trials are required to identify the most suitable treatments for different subgroups of MG patients. In addition, safer and more potent drugs are required as most current drugs have major side effects due to immunosuppression. Therefore, the goal of novel therapies should be increased specificity of the immune-directed agents.
García-Carrasco
Mario
M
Systemic Autoimmune Disease Research Uni, HGZ #36, CMN Manuel Avila Camacho Instituto Mexicano del Seguro Social, Puebla, México.
Escárcega
Ricardo O
RO
Fuentes-Alexandro
Salvador
S
Riebeling
Carlos
C
Cervera
Ricard
R
D001323:Autoantibodies / Q000276:immunology; D002800:Cholinesterase Inhibitors / Q000378:metabolism / Q000627:therapeutic use*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000276:immunology / Q000378:metabolism / Q000627:therapeutic use*; D009157:Myasthenia Gravis / Q000276:immunology / Q000378:metabolism / Q000628:therapy*; D010956:Plasmapheresis; D013934:Thymectomy
D001323:Autoantibodies; D002800:Cholinesterase Inhibitors; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents