Last Saturday, our St. Louis Support Group had the privilege of listening to Dr. Ghazala Hayat present on MG medications and their side effects. Dr. Hayat conducted a thorough presentation on all current and upcoming therapies for myasthenia gravis and needless to say, this is quite an exciting time for the MG community given all the research that is taking place today! Read highlights of the presentation below or simply head to our youtube channel to watch the webinar here.
Interestingly enough, Mestinon, the first line of therapy, was approved by the FDA for the treatment of myasthenia gravis dating back all the way to 1955. Today, Mestinon is still used (even I take it!), however, it can cause a lot of gastrointestinal issues. This particular drug is useful when treating the symptoms of myasthenia gravis but it does not treat the root cause of this disease. For example, as Dr. Hayat pointed out, Mestinon to MG is like Tylenol or Advil to pneumonia; it does not necessarily treat the root cause of pneumonia, but it sure helps alleviate some of the symptoms associated with it.
The next line of therapy involves immunosuppression. Immunosuppressive therapies are implemented when Mestinon is simply not enough, which, for many people with MG, is the case. The goal with immunosuppression is to get to full, or near full symptom remission. Not only does immunosuppressive therapy improve quality of life, but it reduces the risk of exacerbation and developing permanent deficits. Adding these to your treatment regimen early in the diagnostic process is also imperative to reduce the risk of generalization of MG.
While a useful tool to treat MG, immunosuppressive therapies like prednisone have a laundry list of side effects. People who take these drugs often struggle with sleep disturbances, gastritis, bone deterioration, and are prone to developing eye issues such as glaucoma and cataracts. Pro tip: Dr. Hayat recommended adding a banana a day to supplement the calcium in your diet! When taken for an extensive amount of time, immunosuppressive therapies can cause detrimental and unintended effects to the body. That is when immunomodulating therapies are added. The goal is to taper off drugs such as prednisone, however, these treatments can take time (months, even) to actually become effective.
IVIG and plasmapheresis are typically prescribed when MG patients have a myasthenic crisis or need to be prepped for surgery, but many MG patients also use them for maintenance therapy. I happen to utilize subcutaneous immunoglobulin therapy weekly. We originally added this treatment to alleviate an exacerbation I was coping with but now I am using it to hopefully taper off prednisone that I have been on for way too long!
Complement inhibitors such as Soliris are now being used to treat MG, specifically for those with refractory AChR+. An important thing to note with Soliris is that when prescribed, a meningitis vaccine must be taken 2 weeks prior to the first dose of Soliris.
The above drugs mentioned are not the only medications used to treat myasthenia gravis. There are other therapies and drugs in development, potentially taking the place of other drugs that are currently on the market. Should you have questions about a specific treatment or are interested in learning about other medications, please consult your doctor. You can also find our medication list on our website. Special thanks to Dr. Hayat for an incredible and educational webinar on MG treatments and their side effects.
The following blog post was written by Meridith O'Connor, St. Louis Program Coordinator of the Myasthenia Gravis Association.