Chronic Immunotherapy for Myasthenia Gravis
Most people with myasthenia gravis end up taking medication to prevent symptoms from coming on at all. Immunotherapy targets the underlying antibodies that attack the acetylcholine receptors. By changing the immune system, the frequency and severity of attacks are reduced.
Glucocorticoids such as prednisone are often used to suppress the immune system of people with myasthenia. Other options include cyclosporine, azathioprine, and mycophenolate. All of these medications have potential side effects, some of which are quite serious. The risks of the medication must be carefully weighed against the benefits of fewer and less severe attacks of myasthenia.
Rapid Immunomodulating Treatments for Myasthenia Gravis
Whereas chronic immunotherapy agents are intended to work over a long period of time, some situations require quick action. An example would be a myasthenic crisis, or before a surgery or other necessary event that would be expected to possibly exacerbate such a crisis. Rapid immunotherapies work within days, but their benefits only last for weeks, and they are not usually recommended over a long period of time.
Plasma exchange (plasmapheresis) removes antibodies from the circulation. The process is expensive, and typically occurs about five times over 7 to 14 days. Complications can include arrhythmia, blood cell abnormalities, muscle cramps, and more.
Intravenous immunoglobulin (IVIG) has often been shown to be helpful in diseases caused by an autoimmune reaction, but the exact mechanism is unclear. Treatment usually consists of two to five days of injections. Side effects are usually mild but can include renal failure, meningitis, and allergic reactions.