Zur Therapie der Myasthenia gravis stehen eine Reihe gut wirksamer Immunsuppressiva zur Verfügung, die im längerfristigen Verlauf helfen, Steroide einzusparen und damit eine Remission unter möglichst minimalen Nebenwirkungen aufrecht zu erhalten. Die Indikationsstellung zur immunsuppressiven Therapie orientiert sich an der Erkrankungsschwere und Verlaufsdynamik unter Berücksichtigung des Effektes einer evtl. erfolgten Thymektomie. Zugelassen ist zur Myastheniebehandlung derzeit lediglich Azathioprin, sodass andere Substanzen wie Ciclosporin A, Mycophenolatmofetil, Cyclophosphamid und Tacrolimus im Einzelfall off-label verordnet werden müssen.
Immunosuppressive therapy of myasthenia gravis is important for long-term maintenance of remission with minimal side effects. Indication for immunosuppressive treatment is dependent on the severity and course of the disease, and has to take into account the effect of thymectomy which is eventually performed in early-onset generalized myasthenia. Azathioprin is the only drug formally approved for treatment of myasthenia. However, a variety of other immunosuppressants, such as cyclosporine, mycophenolate, cyclophosphamide, and tacrolimus, have also been shown to be effective and can be prescribed off-label as second-line treatment in cases with inefficacy or intolerable side effects of azathioprine.
Key words
myastenia gravis - azathioprin - ciclosporine - cyclophosphamide -
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Korrespondenz
Prof. Dr. med. Sebastian Jander
Neurologische Klinik Universitätsklinikum Düsseldorf Heinrich-Heine-Universität
Moorenstr. 5
40225 Düsseldorf
eMail: jander@uni-duesseldorf.de
