Use of Corticosteroids in Myasthenia Gravis: Expert Opinion for Daily Management

Introduction: Myasthenia gravis, a rare autoimmune disorder characterized by muscle weakness and fatigue, it is a mainly B-cell mediated condition with antibodies directed against the acetylcholine receptor or functionally related molecules at the neuromuscular junction. Corticosteroids are still the most used treatment, as they are cheap and characterized by a rapid response. However, their long-term administration is associated with frequent and often severe side effects. Methods: We used the Expert Opinion methodology: a panel of eight neurologists, known to be experts in the management of MG patients, and one specialist in pharmacoeconomics, were brought together to discuss clinical relevant issues about the use of corticosteroids in MG. Results: Increasing doses of corticosteroids may temporarily exacerbate the symptoms of MG and clinical exacerbations can lead to severe consequences. In addition, prolonged chronic corticosteroid therapy carries a burden in terms of indirect costs due to side effects, which has prompted strategies to obtain the maximum benefits with minimal side effects. Conclusion: The panel concludes that, in the near future, therapeutic strategies based on the use drugs with better tolerability and potentially lower direct and indirect costs, will be necessary.