Myasthenia gravis in clinical practice

Estephan, Eduardo de Paula; Baima, José Pedro Soares; Zambon, A A

doi:10.1590/0004-282x-anp-2022-s105

Cited by 19 publications

(35 citation statements)

References 50 publications

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“…Currently, therapeutic strategies for myasthenia gravis disease are divided into two main groups [108]. One group includes traditional therapies such as the use of nonimmunosuppressants such as pyridostigmine, which is an acetylcholinesterase (AChE) inhibitor that increases the amount of ACh in the synapses [115]. Among the traditional therapies there are also immunosuppressants such as corticosteroids, calcineurin inhibitors (cyclosporine A, tacrolimus), antimetabolites (cyclophosphamide, mycophenolate mofetil and methotrexate), and intravenous immunoglobulin (IVIG) therapy, with a diverse range of mechanisms of action [108,116].…”

Section: Therapeutic Strategiesmentioning

confidence: 99%

Zilucoplan: A Newly Approved Macrocyclic Peptide for Treatment of Anti-Acetylcholine Receptor Positive Myasthenia Gravis

Costa,

Fernandes

2024

DDC

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Zilucoplan is a synthetic macrocyclic peptide approved by the Food and Drug Administration (FDA), in October 2023, for the treatment of generalized myasthenia gravis. It is considered as an orphan drug that causes the inhibition of terminal complement cascade activation with a dual mechanism of action preventing the formation of the membrane attack complex (MAC) and the destruction of the neuromuscular junction. This drug has been demonstrated to be able to treat the generalized myasthenia gravis without significant adverse effects, with good efficacy, safety, and tolerability profile. Zilucoplan is not only innovative and promising in the therapeutics of generalized myasthenia gravis, but it could also be beneficial for the treatment of other diseases as well as a model for synthesis of analogues to improve pharmacological profile.

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Section: Therapeutic Strategiesmentioning

confidence: 99%

Zilucoplan: A Newly Approved Macrocyclic Peptide for Treatment of Anti-Acetylcholine Receptor Positive Myasthenia Gravis

Costa,

Fernandes

2024

DDC

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Section: Introductionmentioning

confidence: 99%

“…Myasthenia gravis is an autoimmune neuromuscular junction disorder that causes fatigue and fluctuating weakness, and it can affect any striated muscle [ 1 ]. Clinically, it can vary from pure ocular weakness to generalized weakness, including the bulbar and respiratory muscles [ 1 ]. Several monoclonal antibodies targeting calcitonin gene-related peptides (CGRP) have been recently approved to treat episodic and chronic migraine [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Galcanezumab-Induced Myasthenia Gravis-Like Symptoms

Mubaraki¹

2023

Cureus

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Fluctuating weakness affecting the ocular, bulbar, and/or appendicular muscles is characteristic of myasthenia gravis. Autoimmune components and certain drugs have been implicated in the pathophysiology of this disease. I report a case of chronic migraine in which the patient developed symptoms of myasthenia gravis after using galcanezumab, the recently approved anti-calcitonin generelated peptide (anti-CGRP). This case shows that anti-CGRP medications could affect the neuromuscular junction and cause such symptoms. Moreover, this case illustrates the clinical approach and management of such a presentation.

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“…Pharmacological testing plays a supportive role in diagnosis; the clinical response to cholinesterase inhibitors aids in affirming the MG diagnosis and may serve as an alternative second-line option to electrodiagnosis. Additionally, requesting computer tomography is essential for thymus screening in patients to aid in managing them [12,16,17]. Myasthenia gravis is characterized by an unpredictable course marked by relapses and occasional remission.…”

Section: Introductionmentioning

confidence: 99%

Depression: A Contributing Factor to the Clinical Course in Myasthenia Gravis Patients

Mihalache,

Vilciu,

Petrescu

et al. 2023

Medicina

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Background and Objectives: The association between myasthenia gravis (MG) and depression is intricate and characterized by bidirectional causality. In this regard, MG can be a contributing factor to depression and, conversely, depression may worsen the symptoms of MG. This study aimed to identify any differences in the progression of the disease among patients with MG who were also diagnosed with depression as compared to those without depression. Our hypothesis focused on the theory that patients with more severe MG symptoms may have a higher likelihood of suffering depression at the same time. Materials and Methods: One hundred twenty-two male and female patients (N = 122) aged over 18 with a confirmed diagnosis of autoimmune MG who were admitted to the Neurology II department of Myasthenia Gravis, Clinical Institute Fundeni in Bucharest between January 2019 and December 2020, were included in the study. Patients were assessed at baseline and after six months. The psychiatric assessment of the patients included the Hamilton Depression Rating Scale-17 items (HAM-D), and neurological status was determined with two outcome measures: Quantitative Myasthenia Gravis (QMG) and Myasthenia Gravis Activities of Daily Life (MG-ADL). The patients were divided into two distinct groups as follows: group MG w/dep, which comprised 49 MG patients diagnosed with depressive disorder who were also currently receiving antidepressant medication, and group MG w/o dep, which consisted of 73 patients who did not have depression. Results: In our study, 40.16% of the myasthenia gravis (MG) patients exhibited a comorbid diagnosis of depression. Among the MG patients receiving antidepressant treatment, baseline assessments revealed a mean MG-ADL score of 7.73 (SD = 5.05), an average QMG score of 18.40 (SD = 8.61), and a mean Ham-D score of 21.53 (SD = 7.49). After a six-month period, a statistically significant decrease was observed in the MG-ADL (2.92, SD = 1.82), QMG (7.15, SD = 4.46), and Ham-D scores (11.16, SD = 7.49) (p < 0.0001). These results suggest a significant correlation between MG severity and elevated HAM-D depression scores. Regarding the MG treatment in the group with depression, at baseline, the mean dose of oral corticosteroids was 45.10 mg (SD = 16.60). Regarding the treatment with pyridostigmine, patients with depression and undergoing antidepressant treatment remained with an increased need for pyridostigmine, 144.49 mg (SD = 51.84), compared to those in the group without depression, 107.67 mg (SD = 55.64, p < 0.001). Conclusions: Our investigation confirms that the occurrence of depressive symptoms is significantly widespread among individuals diagnosed with MG. Disease severity, along with younger age and higher doses of cortisone, is a significant factor associated with depression in patients with MG. Substantial reductions in MG-ADL and QMG scores were observed within each group after six months, highlighting the effectiveness of MG management. The findings suggest that addressing depressive symptoms in MG patients, in addition to standard MG management, can lead to improved clinical outcomes.

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Myasthenia gravis in clinical practice

Cited by 19 publications

References 50 publications

Zilucoplan: A Newly Approved Macrocyclic Peptide for Treatment of Anti-Acetylcholine Receptor Positive Myasthenia Gravis

Zilucoplan: A Newly Approved Macrocyclic Peptide for Treatment of Anti-Acetylcholine Receptor Positive Myasthenia Gravis

Galcanezumab-Induced Myasthenia Gravis-Like Symptoms

Depression: A Contributing Factor to the Clinical Course in Myasthenia Gravis Patients

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