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Review

Treatment of myasthenia gravis: current practice and future directions

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Pages 743-748 | Published online: 10 Jan 2014

References

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  • ••Systemic review of the controlled, but notrandomized studies describing outcomes in MG patients undergoing and not undergoing thymectomy. It concludes that thymectomy is recommended as an option to increase the probability of remission or improvement in patients with nonthymomatous autoimmune MG, based on Class 11 evidence.
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  • ••Guidelines developed by a Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America include a revised Clinical Classification, a MGFA Therapy Status, MGFA Postintervention Status, Thymectomy classification and recommendations to develop clinical outcome measures specific for MG.
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  • Ciafaloni E, Nikhar N, Massey JM, Sanders DB. Retrospective analysis of the use of cyclosporin in myasthenia gravis. Neurology 55, 448–450 (2000).
  • •Retrospective analysis of the use of cyclosporin in 57 MG patients taking this drug for an average of 3.5 years and showed clinical improvement in 96%. Side effects included malignancy in 11% and elevation of serum creatinine in 28% of the patients.
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  • ••An open-label trial of MIVI, in whichimprovement was demonstrated in eight out of 12 patients who had refractory MG, or who were taking only corticosteroids and required additional imrnunosuppression. No major side effects were observed.
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  • •The consensus of an expert panel is that MG is effective in reversing myasthenic weakness and appears to have a role as an acute treatment intervention in rapidly progressive weakness, or as a chronic maintenance therapy when all other treatment modalities have failed.
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  • •• A single monoclonal antibody against a complementary peptide for the dominant T-cell epitope on the AChR lessened the incidence and severity of EAMG.
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