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Treatment-Refractory Myasthenia Gravis

Silvestri, Nicholas J. MD; Wolfe, Gil I. MD

Journal of Clinical Neuromuscular Disease: June 2014 - Volume 15 - Issue 4 - p 167–178
doi: 10.1097/CND.0000000000000034
Review Article
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Myasthenia gravis (MG) is the most common disorder of neuromuscular transmission and is a prototypical autoimmune disorder. Most patients with MG are successfully treated with acetylcholinesterase inhibitors, corticosteroids, and/or steroid sparing agents such as azathioprine and mycophenolate mofetil. There is a small subset of patients, however, with treatment-refractory disease. In these cases, medications such as rituximab, high-dose cyclophosphamide, and eculizumab may be used. Thymectomy (in some cases repeat thymectomy) is another option in selected patients. Studies evaluating these and other forms of therapy in treatment-refractory MG are reviewed.

Department of Neurology, State University of New York, Buffalo School of Medicine and Biomedical Sciences, Buffalo General Medical Center, Buffalo, NY.

Reprints: Nicholas J. Silvestri, MD, State University of New York, Buffalo School of Medicine and Biomedical Sciences, Buffalo General Medical Center, 100 High St, Buffalo, New York 14203 (e-mail: njs6@buffalo.edu).

The authors report no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins