What are the treatment options for myasthenia gravis if first-line fail?

If the patient with myasthenia gravis (MG) has been taking adequate doses of a fi rst-line medication, typically pyridostigmine, for a suffi cient duration but without signifi cant effi cacy, or has experienced substantial adverse effects, it may be time to consider immunosuppressive therapy. In 5% to 20% of patients, there may be suboptimal effi cacy or prohibitive adverse effects with high-dose corticosteroid therapy over a period of a few weeks to 3 months.1–3 For these patients, nonsteroidal immunosuppressive therapy should be considered early instead of continuing high-dose corticosteroids for a longer duration. A targeted examination will help determine if pyridostigmine or other treatment has failed. © 2023, Cleveland Clinic Journal of Medicine. All Rights Reserved.