Managing Corticosteroids and Immunosuppression in MG

In this episode, ‘Managing Corticosteroids and Immunosuppression in MG,’ the panelists explore how established therapies continue to fit within an increasingly complex treatment landscape. Expert faculty discuss how initial therapy is individualized according to clinical presentation, rate of disease progression, antibody status, age, sex, comorbidities, and treatment goals.

The discussion focuses heavily on corticosteroid use and the importance of limiting long-term exposure. Panelists describe using lower corticosteroid doses when appropriate and emphasize that adverse effects may emerge much earlier than clinicians or patients expect. Osteoporosis, metabolic complications, reflux, mood effects, and other toxicities can influence whether corticosteroids are initiated, how aggressively they are dosed, and how quickly steroid-sparing immunosuppressive therapy is introduced.

The faculty also discuss the potential for transient worsening after corticosteroid initiation or dose escalation, underscoring the importance of careful patient selection and monitoring when higher doses are considered. They compare daily and alternate-day approaches and describe how tapering strategies may vary according to clinical response.

A key discussion centers on distinguishing recurrence of MG symptoms from consequences of corticosteroid withdrawal. The panel notes that adrenal suppression may contribute to fatigue or worsening symptoms during or after a prednisone taper and can potentially be mistaken for renewed MG activity. Experts emphasize that this possibility deserves greater consideration when evaluating patients after dose reductions.

The next episode in this series, ‘Positioning Upstream and Downstream Therapies in MG,’ features the panelists comparing FcRn and complement inhibition and examining how moving upstream toward B-cell targeting may alter therapeutic strategy.