Unmet Needs in the Management of Myasthenia Gravis


A. Gordon Smith, MD, FAAN, recounts the challenges of treating patients with myasthenia gravis. He also discusses care disparities and the need for rapid disease modification.

A. Gordon Smith, MD, FAAN: There are several unmet needs in managing myasthenia gravis, some of which are pretty obvious in others, less so. One that is pretty obvious is not every patient with myasthenia gravis responds to typical standard-of-care treatments. Of course, these patients would benefit from other treatment options. Another obvious one is patients that have adverse effects or side effects from standard-of-care therapies. Here corticosteroids—prednisone or pulsed intravenous steroids—cause significant side effects for many patients. There are some patients where these are difficult to manage. There are others where we're able to successfully taper the steroid dose such that it doesn't. Patients who are either having side effects from steroids or who really aren't appropriate for steroid use; patients who have diabetes or who are obese or have significant hypertension, this can be a bit of a conundrum.

One area that I don't think we give enough attention to is ocular myasthenia. There's a tendency for neurologists to think of this as being the mild form of myasthenia gravis, but when you talk to patients or measure their quality of life, ocular symptoms, so double vision, and diplopia are very disabling to patients. It's not just fighter pilots and brain surgeons that don't tolerate double vision very well. All of us struggle with it. I think there's opportunity for management in ocular myasthenia.

Care disparities are a major issue really across all of medicine, but particularly in myasthenia gravis. We've already talked a little bit about the path to diagnosis. There's evolving data, suggesting that patients who are suspect to significant care disparities aren't diagnosed quickly enough and they aren't often given the same access to care that those who do not have care disparities are offered.

I think there's perhaps an opportunity to focus on rapid diagnosis and disease modification. I think there's the beginning of a scientific evidence base about the importance of early and aggressive intervention in myasthenia gravis.

Transcript edited for clarity

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