Self-Assessment: Immune Mediated Peripheral Neuropathies | Paradigm Clashes: Debate & Exploration in Choosing Traditional vs Novel Immunotherapeutics for MG-Paradigm Clashes: Dr. Claytor Presentation

Paradigm Clashes: Dr. Claytor Presentation

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Dr. Benjamin Claytor of the Cleveland Clinic's Neuromuscular Center advocates for the continued use of traditional immunotherapies for myasthenia gravis (MG), despite the development of newer treatments. Traditional therapies, preceding the approval of eculizumab in 2017, include corticosteroids like prednisone, non-steroidal immunosuppressive treatments (NSITs) such as azathioprine and mycophenolate mofetil, rescue therapies like immune globulin and plasma exchange, biologics such as rituximab, and thymectomy. These therapies are deemed effective, safe, affordable, and applicable to all MG subtypes, aligning well with ideal MG treatment criteria.<br /><br />The document underscores the strong track record of traditional therapies in providing effective management for a broad range of MG patients. Long-term data and extensive experience with these treatments have shown them to produce better outcomes in many cases compared to novel therapies, such as complement inhibitors and FcRN antagonists, which often fall short in terms of cost-effectiveness and long-term efficacy.<br /><br />Corticosteroids, particularly prednisone, are highlighted for their affordability and effectiveness, achieving significant patient improvement and remission—in some cases up to 80-90%. Despite concerns about side effects like steroid-induced exacerbations, when doses are managed carefully, corticosteroids remain a safe long-term option.<br /><br />NSITs serve a crucial role in reducing steroid dependency over time, enhancing treatment efficacy, and minimizing side effects. Other options like immune globulin therapy and plasmapheresis are critical for severe crises, providing short-term anti-inflammatory benefits.<br /><br />The document also notes that, while new MMF and azathioprine trials have shown limited early benefits compared to steroids, NSITs carry lower long-term cancer risks with manageable doses and durations. Given these comprehensive insights, Dr. Claytor concludes that traditional therapies should remain the first-line treatment for most MG patients.

Keywords

myasthenia gravis

traditional immunotherapies

corticosteroids

prednisone

non-steroidal immunosuppressive treatments

azathioprine

mycophenolate mofetil

immune globulin

plasma exchange

Dr. Benjamin Claytor