Treating myasthenia on consensus guide: Helpful and challenging but still unfinished business

Myasthenia gravis (MG) is the prototypic autoimmune disease and the most gratifying because it is treatable in most cases. Although in successful clinics it is no longer considered “gravis,” it does require high doses of corticosteroids to induce remission, and immunosuppressants, such as azathioprine, mycophenolate, cyclosporine, methotrexate, or tacrolimus, for steroid-sparing treatment, even though their efficacy is variable and based on small-scale underpowered trials.1–3 IV immunoglobulin (IVIg) and plasmapheresis provide life-saving short-term benefit for crises or difficult cases and probably account for the reduced mortality witnessed over the last 20 years.1