Therapiestandards und individualisierte Therapie bei der Myasthenia gravis

Zusammenfassung

Für die Myasthenia gravis stehen eine Reihe gut etablierter Therapiestandards zur Verfügung, die sowohl die symptomatische Therapie mit Acetylcholinesterasehemmern als auch eine breite Palette immunologisch-basierter Therapien umfassen. Hiermit lässt sich bei der Mehrzahl der Patienten ein gutes Therapieergebnis mit weitgehender Beschwerderemission erzielen. Für die optimale individualisierte Therapie bietet die Behandlung in spezialisierten Myastheniezentren mit der Integration ambulanter und stationärer Infrastruktur und breiter interdisziplinärer Kompetenz entscheidende Vorteile.

Abstract

For myasthenia gravis, a wide array of established treatment options is currently available. These include cholinesterase inhibitors for symptomatic treatment and a broad spectrum of immunosuppressive, immunomodulating or cell-depleting options to modify the underlying immunological process. Appropriate use enables a great majority of patients to lead a normal life. For optimum patient-tailored therapy, specialized centres integrating outpatient and inhospital resources as well as interdisciplinary competences offer decisive advantages.

Schlüsselwörter

Myasthenia gravis - neuromuskuläre Übertragungsstörung - Therapie

Keywords

myasthenia gravis - neuromuscular disorder - treatment

• Literatur

• 1 Gilhus NE, Verschuuren JJ. Myasthenia gravis: subgroup classification and therapeutic strategies. Lancet Neurol 2015; 14: 1023-1036
• 2 Aeschlimann JA, Reinert M. Pharmacological action of some analogues of physiostigmine. J Pharmacol Exp Ther 1931; 43: 413-444
• 3 Remen L. Zur Pathogenese und Therapie der Myasthenia gravis pseudoparalytica. Dtsch Z Nervenheilkunde 1932; 128: 66-78
• 4 Walker MB. Treatment of myasthenia gravis with physostigmine. Lancet 1934; 1: 1200-1201
• 5 Nair VP, Hunter JM. Anticholinesterases and anticholinergic drugs. Continuing Education in Anaesthesia, Critical Care & Pain 2004; 4: 164-168
• 6 Maggi L, Mantegazza R. Treatment of myasthenia gravis. Focus on Pyridostigmine. Clin Drug Investig 2011; 31: 691-701
• 7 Deutsche Gesellschaft für Neurologie (DGN). Leitlinien der DGN: Diagnostik der Myasthenia gravis und des Lambert-Eaton-Syndroms (29.06.2015). Im Internet: http://www.dgn.org/leitlinien/3005-ll-68-ll-diagnostik-und-therapie-der-myasthenia-gravis-und-des-lambert-eaton-syndroms
• 8 Mehndiratta MM, Pandey S, Kuntzer T. Acetylcholinesterase inhibitor treatment for myasthenia gravis. Cochrane Database Syst Rev 2014; CD006986.
• 9 Punga RA, Stalberg E. Acetylcholinesterase inhibitors in myasthenia gravis: To be or not to be?. Muscle Nerve 2009; 39: 724-728
• 10 Wolfe GI, Kaminski HJ, Aban IB. et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med 2016; 375: 511-522
• 11 Pascuzzi RM, Coslett HB, Johns TR. Long-term corticosteroid treatment of myasthenia gravis: report of 116 patients. Ann Neurol 1984; 15: 291-298
• 12 Schneider-Gold C, Gajdos P, Toyka KV. et al. Corticosteroids for myasthenia gravis. Cochrane Database Syst Rev 2005; 2: CD002828
• 13 Seybold ME, Drachman DB. Gradually increasing doses of prednisone in myasthenia gravis. Reducing the hazards of treatment. N Engl J Med 1974; 290: 81-84
• 14 Palace J, Newsom-Davis J, Lecky B. A randomized double-blind trial of prednisolone alone or with azathioprine in myasthenia gravis. Myasthenia Gravis Study Group. Neurology 1998; 50: 1778-1883
• 15 Gronseth GS, Barohn RJ. Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000; 55: 7-15
• 16 Iorio R, Damato V, Alboini PE. et al. Efficacy and safety of rituximab for myasthenia gravis: a systematic review and meta-analysis. J Neurol 2015; 262: 1115-1119
• 17 Hohlfeld R, Michels M, Heininger K. et al. Azathioprine toxicity during long-term immunosuppression of generalized myasthenia gravis. Neurology 1988; 38: 258-261
• 18 Hohlfeld R, Toyka KV, Besinger UA. et al. Myasthenia gravis: reactivation of clinical disease and of autoimmune factors after discontinuation of long-term azathioprine. Ann Neurol 1985; 17: 238-242
• 19 Pedersen EG, Pottegard A, Hallas J. et al. Myasthenia and risk of cancer: a population-based case-control study. Eur J Neurol 2014; 21: 773-778
• 20 Pedersen EG, Pottegard A, Hallas J. et al. Risk of non-melanoma skin cancer in myasthenic patients treated with azathioprine. Eur J Neurol 2014; 21: 454-455
• 21 Muscle Study Group. A trial of mycophenolate mofetil with prednisone as initial immunotherapy in myasthenia gravis. Neurology 2008; 71: 394-399
• 22 Sanders DB, Hart IK, Mantegazza R. et al. An international, phase III, randomized trial of mycophenolate mofetil in myasthenia gravis. Neurology 2008; 71: 400-406
• 23 Hehir MK, Burns TM, Alpers J. et al. Mycophenolate mofetil in AchR-antibody-positive myasthenia gravis: outcomes in 102 patients. Muscle Nerve 2010; 41: 593-598
• 24 Meriggioli MN, Ciafaloni E, Al-Hayk KA. et al. Mycophenolate mofetil for myasthenia gravis. Neurology 2003; 61: 1438-1440
• 25 Hobbson-Webb LD, Hehir M, Crum B. et al. Can mycophenolate mofetil be tapered safely in myasthenia gravis? A retrospective, multicenter analysis. Muscle Nerve 2015; 52: 211-215
• 26 Lim AKH, Donnan G, Chambers B. et al. Mycophenolate mofetil substitution for cyclosporine-dependent myasthenia gravis and nephrotoxicity. Intern Med J 2007; 37: 55-59
• 27 Oskarsson B, Rocke DM, Dengel K. et al. Myasthenia gravis exacerbation after discontinuing mycophenolate. Neurology 2016; 86: 1-5
• 28 Heckmann JM, Rawoot A, Bateman K. et al. A single-blinded trial of methotrexate versus azathioprine as steroid-sparing agents in generalized myasthenia gravis. BMC Neurology 2011; 11: 97
• 29 Pasnoor M, He J, Herbelin L. et al. A randomized controlled trial of methotrexate for patients with generalized myasthenia gravis. Neurology 2016; 87: 57-64
• 30 Braun J, Kaestner P, Flaxenberg P. et al.; MC-MTX.6/RH Study Group. Comparison of the clinical efficacy and safety of sucutaneous versus oral administration of methotrexate patients with active rheumatoid arthritis. Arthritis Rheum 2008; 58: 73-81
• 31 Nagane Y, Suzuki S, Suzuki N. et al. Two-year treatment with cyclosporine microemulsion for responder myasthenia gravis patients. Eur Neurol 2010; 64: 186-190
• 32 Tindall RSA, Rollins JA, Phillips JT. et al. Preliminary results of a double blind, randomized, placebo-controlled trial of cyclosporine in myasthenia gravis. N Engl J Med 1987; 316: 719-724
• 33 Ciafoloni E, Nikhar NK, Massey JM. et al. Retrospective analysis of the use of cyclosporine in myasthenia gravis. Neurology 2000; 55: 448-450
• 34 Ponseti JM, Gamez J, Azem J. et al. Tacrolimus for myasthenia gravis: a clinical study of 212 patients. Ann NY Acad Sci 2008; 1132: 254-263
• 35 Cruz JL, Wolff ML, Vanderman AJ. et al. The emerging role of tacrolimus in myasthenia gravis. Ther Adv Neurol Disord 2015; 8: 92-103
• 36 Nagaishi A, Yukitake M, Kuroda Y. Long-term treatment of steroid-dependent myasthenia gravis patients with low-dose tacrolimus. Inter Med 2008; 47: 731-736
• 37 Eienbröker C, Seitz F, Spengler A. et al. Intravenous immunoglobulin maintainance treatment in myasthenia gravis: a randomized, controlled trial sample size simulation. Muscle Nerve 2014; 50: 999-1004
• 38 Liew WKM, Powell CA, Sloan SR. et al. Comparison of plasmapheresis and intravenous immunoglobulin as maintenance therapies for juvenile myasthenia gravis. JAMA Neurol 2014; 71: 575-580
• 39 Zinman L, NG E, Bril V. et al. IV immunoglobulin in patients with myasthenia gravis: a randomized controlled trial. Neurology 2007; 68: 837-841
• 40 Kupersmith MJ, Latkany R, Homel P. Development of generalized disease at 2 years in patients with ocular myasthenia gravis. Arch Neurol 2003; 60: 243-248
• 41 Köhler W, Sieb JP. Hrsg. Myasthenia gravis. Bremen: Uni-Med Verlag; 2012
• 42 Engel AG. ed. Myasthenia gravis and Myasthenic Disorders. Oxford: Oxford University Press; 2012