Collaborating With Primary Care Physicians for the Management of Patients With Myasthenia Gravis


A. Gordon Smith, MD, FAAN, talks about the importance of collaboration and education amid advances in myasthenia gravis treatment, from new formulations and routes of administration to innovative targets.

A. Gordon Smith, MD, FAAN: The diagnosis and treatment of myasthenia gravis really is a collaboration between the general or comprehensive neurologists, neuromuscular neurologists, and primary care or community-based physicians. I think all of us have a role to play in this. For the community physician or primary care colleagues, really recognizing myasthenia is incredibly important and I think there's a lot of reason to do so now given the extremely exciting therapeutic environment in which we're working. My hope for community and primary care physicians is to be familiar with myasthenia as a disease and recognize how it presents and refer quickly to a neurologist or neuromuscular neurologist to help diagnose and manage that patient. We often rely on our primary care colleagues to help manage medical comorbidities, so patients who have diabetes, who we are using corticosteroids on, for instance, or who have other comorbidities, such as thyroid disease, etc. For our general and comprehensive neurology colleagues and for other neuromuscular neurologists really being mindful of the therapeutic repertoire. We are entering an era where we don't have to accept moderate response to therapy. We need to make sure that our patients are responding appropriately and listen to their voices and treat them with intent to get them to a point where they're not having any symptoms, to so-called minimal manifestations, where they might have mild weakness that isn't therapeutically or rather clinically meaningful for them, which means holding ourselves to a higher standard of therapeutic success and taking advantage of these agents.

We do as a community need to come together and think about how we best provide these therapies to all patients, including those who may not have robust access to all the resources that others do, and this poses a number of challenges. The first line of defense for our patients who are suspect to healthcare disparities is to recognize these just logistical challenges, travel, travel to clinic, payer coverage, and help with them. We do need to think of the expensive therapy. This isn't a large issue going forward, and that's only going to be solved collaboratively with patients, payers, and pharmaceutical companies.

For anyone who happens to be listening to this that hasn't already made up their mind to be a neuromuscular neurologist, it's a really fun time to be in the business of serving patients with myasthenia gravis given there's so much we can do to help them.

Transcript edited for clarity

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