Managing gMG
Management strategies for myasthenia gravis (MG) aim at restoring the patients’ muscle strength and well-being by controlling the disease and its symptoms, while reducing potential medication side effects.1,2
After receiving any treatment for MG, patients can expect an evaluation of their symptoms and muscle weakness along with monitoring of potential medication side effects over time.1–3
Depending on the treatment, patients may need to wait for variable periods of time before an evaluation of the treatment effect is possible.1,4
Steroids, also known as corticosteroids, are usually administered orally in patients with MG, though other ways of administration are possible such as infusion into a vein.1,2,5,8 The dose and duration of administration are adjusted depending on the severity of the disease, individual patient factors and side effects.1,2 A therapeutic effect from steroids may be seen within a few weeks after administration.1 When taking steroids for long periods, side effects such as problems with the bones or skin, weight gain or increased risk of infections may be experienced by some patients.1 The number and severity of side effects differ among patients and depend on the steroid dose and duration of use.8
Non-steroidal immunosuppressive drugs can be used together with steroids or taken alone when steroid use is not possible.1,3,5 The type, route of administration, dose and duration of treatment with non-steroidal immunosuppressive drugs in patients with MG is decided by healthcare professionals on a case-by-case basis.1,3,5 The time period for seeing a therapeutic effect from non-steroidal immunosuppressive drugs may vary between months and years after administration depending on the chosen drug.1,5
Some patients with MG may receive short-term immunosuppressive therapies.1,3 This can be, for example, the case in patients who need a treatment with a rapid effect such as patients with severe symptoms or who experience a life-threatening condition due to MG, in patients who are in preparation for surgeries or in patients who are about to start treatment with steroids and potential worsening of symptoms needs to be prevented.1,3 Two commonly used short-term immunosuppressive therapies are the so-called plasma exchange and intravenous immunoglobulin.1,3 It should be noted that these therapies may also be used as long-term treatment in some patients.1,3
Plasma exchange (sometimes called plasmapheresis) is a therapeutic procedure used to remove abnormal components such as antibodies and proteins from the patient’s blood.1,9 In preparation for plasma exchange, a needle is usually inserted into a vein in each of the patient’s arms.9 The patient may then rest on a reclining chair or bed while a machine draws blood from one arm, exchanges it and returns it to the other arm, using replacement plasma – the liquid component of the blood.9,10 The procedure may last several hours9 and may be repeated for several cycles on different days.10
Intravenous immunoglobulin refers to a solution containing antibodies (immunoglobulins) collected from many healthy donors.8 It is injected into a vein in the arm using an infusion pump.11 The dose and duration of the infusion is individualised for each patient and may be repeated for several cycles on different days.8,11