Maintenance immunosuppression in myasthenia gravis

Therapies for myasthenia gravis (MG) include symptomatic and immunosuppressive treatment. Options for immunosuppression include corticosteroids, azathioprine, mycophenolate mofetil, cyclosporine, tacrolimus, methotrexate, rituximab, cyclophosphamide, intravenous immunoglobulin, plasmapheresis, and thymectomy. The practical aspects of long-term immunosuppressive therapy in MG will be critically reviewed in this article. Treatment for ocular and generalized myasthenia gravis will be discussed. Application of these therapies needs to be considered in conjunction with their efficacy, disease subtypes and severity, and patient co-morbidities.