Myasthenia gravis (MG): non-steroid immunosuppression: agents

Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .

Myasthenia gravis (MG): non-steroid immunosuppression: agents. This is the first line non-steroid option. Fully referenced neurology checklist.

Azathioprine

  • This is the first line non-steroid option
  • It is administered if MPTP level is sufficient: this is the enzyme that metabolises Azathioprine
  • The dose is built up over one month to 2.5mg/kg body weight daily
  • Weekly blood tests are required during dose titration
  • Also see Neurochecklist: “Azathioprine”

Methotrexate

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Rituximab

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Ciclosporin

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Mycophenolate

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Cyclophosphamide

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Eculizumab

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Ravulizumab

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Efgartigimod

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Rozanolixizumab

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Zilucoplan

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Recently approved agents

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References

  1. Skeie GO, Apostolski S, Evoli A, et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol 2010; 17:893-902.
  2. Sanders DB, Wolfe GI, Benatar M, et al. International consensus guidance for management of myasthenia gravis: executive summary. Neurology 2016; 87:419-425.
  3. Sathasivam S. Steroids and immunosuppressant drugs in myasthenia gravis. Nat Clin Pract Neurol 2008; 4:317-327.
  4. Heckmann JM, Rawoot A, Bateman K, Renison R, Badri M. A single-blinded trial of methotrexate versus azathioprine as steroid-sparing agents in generalized myasthenia gravis. BMC Neurology 2011; 11:97.
  5. Prado MB Jr, Adiao KJB. Methotrexate in generalized myasthenia gravis: a systematic review. Acta Neurol Belg 2023 (Online ahead of print).
  6. And 12 more. Subscribe to see the full list

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