Azathioprine in myasthenia gravis

Symptomatic treatment with acetylcholinesterase inhibition is usually combined with immunosuppression. (1)

The cholinesterase inhibitor pyridostigmine is part of initial treatment for most patients with either ocular or generalised MG, with the dose depending on the severity of symptoms.

A corticosteroid such as prednisolone is used for patients in whom pyridostigmine monotherapy is not effective.

For patients in whom corticosteroids are contraindicated and patients requiring high doses of corticosteroids, other immunosuppressants may be considered. These other immunosuppressants may be used instead of a corticosteroid, or in combination in order to allow dose reduction (i.e., as a corticosteroid-sparing agent).

Azathioprine is recommended as the first-line immunosuppressive treatment for MG, based on effectiveness and tolerability. (1, 2)

Other immunosuppressive agents that may be considered include ciclosporin, tacrolimus, mycophenolate, and methotrexate.(1)

Reference:

1. Sanders DB, Wolfe GI, Benatar M, et al. International consensus guidance for management of myasthenia gravis: executive summary. Neurology. 2016 Jul 26;87(4):419-25.
2. Farmakidis C, Pasnoor M, Dimachkie MM, et al; Treatment of Myasthenia Gravis. Neurol Clin. 2018 May;36(2):311-337