https://www-uptodate-com.offcampus.lib.washington.edu/contents/chroni...

www.uptodate.com

peer review process

1-5

immune globulin

azathioprine mycophenolate
cyclosporine tacrolimus

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"Overview of the treatment of myasthenia gravis" "Myasthenic

crisis"

pyridostigmine

table 1

2
6
prednisone

7,8

prednisone

azathioprine mycophenolate immune globulin

'Glucocorticoid-sparing therapy'
'Use of IVIG as "bridge" therapy'

8,9

"Myasthenic crisis", section on 'Rapid therapies'

prednisone

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of transient worsening. (See 'Initial dose escalation'

10

"Myasthenic
crisis", section on 'Rapid therapies'

prednisone

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'Glucocorticoid-sparing therapy'

"Major side effects of systemic glucocorticoids"

"Prevention and treatment of glucocorticoid-induced

osteoporosis"

prednisone
"Treatment and prevention of
Pneumocystis pneumonia in HIV-uninfected patients", section on 'Prophylaxis'

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patients with toxicities of chronic steroids.

Azathioprine mycophenolate

cyclosporine tacrolimus methotrexate

table 1

azathioprine
2 Mycophenolate

cyclosporine
tacrolimus

Azathioprine

11-14
prednisolone
15

Mycophenolate
2
azathioprine

16-18 prednisone

16

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mycophenolate 19-22

prednisone 19

Cyclosporine tacrolimus
azathioprine mycophenolate

Cyclosporine

23-27 25

prednisone cyclosporine
24

Tacrolimus

prednisolone
28

29

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tacrolimus
30-34

34 Prednisone

Methotrexate
35

prednisone

36

MuSK-positive MG

azathioprine mycophenolate

Rituximab

azathioprine mycophenolate
'Rituximab'

Pyridostigmine prednisone

prednisone azathioprine

mycophenolate cyclosporine tacrolimus

"Safety of rheumatic disease medication use during pregnancy and lactation", section on
'Azathioprine and 6-mercaptopurine'

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As with azathioprine cyclosporine tacrolimus

"Safety of rheumatic disease medication use during pregnancy and lactation", section on
'Cyclosporine' "Safety of rheumatic disease medication use during pregnancy and lactation",
section on 'Tacrolimus'

Mycophenolate

"Safety of rheumatic disease medication use during pregnancy and

lactation", section on 'Mycophenolate mofetil'

"Management of myasthenia gravis in pregnancy"

azathioprine
mycophenolate

azathioprine
mycophenolate
cyclosporine 'AChR-positive and seronegative
MG'

azathioprine
prednisone 37

Azathioprine

azathioprine
prednisone

'AChR-positive and
seronegative MG'

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Before starting azathioprine

Clinical
Pharmacogenetics Implementation Consortium 38
PharmGKB "Overview of pharmacogenomics", section on 'Thiopurines and
polymorphisms in TPMT and NUDT15'

Azathioprine

azathioprine

"Pharmacology and side effects of azathioprine when used in rheumatic diseases"

azathioprine

Azathioprine

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little concern, but it can be used as a means to assess dosing and compliance [39

azathioprine 40

"Pharmacology and side effects of azathioprine when used in

rheumatic diseases", section on 'Malignancy'

azathioprine
allopurinol febuxostat

Mycophenolate

prednisone
azathioprine 'AChR-positive and seronegative MG'

mycophenolate

mycophenolate

"Mycophenolate: Overview of use and

adverse effects in the treatment of rheumatic diseases"

mycophenolate
azathioprine

41-44

Cyclosporine

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responses. Clinical benefit in MG can often be appreciated as early as one to two months after

'AChR-positive and seronegative MG'

cyclosporine

cyclosporine

"Cyclosporine and tacrolimus nephrotoxicity"

cyclosporine

25 "Pharmacology of cyclosporine
and tacrolimus", section on 'Side effects'

cyclosporine

Tacrolimus
cyclosporine

'AChR-positive and seronegative MG'

tacrolimus

34

28,29

Tacrolimus cyclosporine

28-34,45,46

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tacrolimus

46

tacrolimus
"Pharmacology of cyclosporine and tacrolimus", section on 'Side effects'

Azathioprine
prednisone

azathioprine prednisone

pyridostigmine
"Overview of the treatment of myasthenia
gravis", section on 'Initial symptomatic therapy'

pyridostigmine

prednisone
immune globulin

2
"Overview of the treatment of myasthenia gravis", section on 'Plasma exchange and IVIG as
rescue or bridge therapies'

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Definition and general approach

azathioprine mycophenolate cyclosporine tacrolimus 47,48

immune globulin

azathioprine mycophenolate
cyclosporine
tacrolimus

2
Eculizumab

rituximab cyclophosphamide 2

Eculizumab

Eculizumab

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AChR-positive, refractory MG [49

50

51

Eculizumab

50-52

Eculizumab

53

"Treatment and prevention of meningococcal infection", section

on 'Patients receiving C5 inhibitors'

eculizumab

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in clinical trials include headache (16 to 38 percent), nasopharyngitis (15 to 32 percent), diarrhea

51

Rituximab

rituximab 54-56

prednisone
57

58

Rituximab
54,59-63

54

63

prednisone

rituximab

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initial dose is 375 mg/m

63

Rituximab

"Infusion-related reactions to therapeutic monoclonal antibodies used for cancer therapy"

rituximab
35,36 "Progressive multifocal
leukoencephalopathy: Epidemiology, clinical manifestations, and diagnosis"

"Overview of the treatment of

myasthenia gravis", section on 'Plasma exchange and IVIG as rescue or bridge therapies'

Cyclophosphamide

cyclophosphamide

64

cyclophosphamide 65

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prednisone

cyclophosphamide
66

A novel approach to refractory patients with myasthenia involves the use of high-dose
cyclophosphamide 67,68

cyclophosphamide

64,65
"General principles of the use
of cyclophosphamide in rheumatic diseases"

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69,70

71

NCT03669588

Tocilizumab
72

Ruxolitinib

73

74

75

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"Society guideline links: Myasthenia gravis" "Society

guideline links: Thymomas and thymic carcinomas"

immune globulin

'Introduction'

pyridostigmine

Grade 1B prednisone

'Glucocorticoids'

prednisone

'Approach to tapering'

prednisone
'Side effects and monitoring'

Grade 1B

azathioprine mycophenolate
Grade 2C cyclosporine tacrolimus

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intolerant of or unresponsive to an adequate trial of azathioprine or mycophenolate

'AChR-positive and seronegative MG'

rituximab Grade 2C

azathioprine mycophenolate

'Rituximab'

azathioprine mycophenolate
table 1
prednisone

'Administration of specific drugs' 'Management of

concurrent prednisone'

azathioprine
mycophenolate cyclosporine tacrolimus

eculizumab rituximab 'Definition and general

approach'

Cyclophosphamide

eculizumab rituximab
'Cyclophosphamide'

Subscription and License Agreement

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Topic 5175 Version 33.0

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