Immuntherapie bei Myasthenia gravis und Lambert-Eaton-Syndrom

2010 
The treatment of myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) is - according to the guidelines of the German Neurological Society - very effective in most patients. Nevertheless due to the individual course of both diseases, adverse drug effects or severe comorbidities, it is often necessary to stop the treatment with the „classical” immunotherapeutics such as corticosteroids and azathioprine and to change to other drugs in spite of the fact that experience using them is much more scarce and that the drugs can only be given off-label. The Medical Advisory Board of the German Myasthenia Society (DMG) has therefore updated the available scientific data concerning these drugs (methotrexate, cyclophosphamide, cyclosporine, mycophenolate mofetil, tacrolimus, rituximab) with respect to indications and approval, study results, practical application and monitoring of therapy as well as adverse events and complications. Moreover, for each of these drugs, some practical information concerning pregnancy and breast-feeding is given. This publication is intended to demonstrate additional treatment modalities even in severe cases of MG or LEMS. Moreover, it may offer some arguments for the off-label-use of these drugs. In a second part of this publication, the treatment with high-dose immunoglobulins, plasma exchange and immunoadsorption will be discussed.
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