J Mult Scler Neuroimmunol.
2024 Dec;15(2):59-71. 10.59578/jmsni.2024.15.2.59-71.
National Consensus Guidance for Management of Refractory Myasthenia Gravis
- Affiliations
-
- 1Department of Neurology, National Medical Center, Seoul, Korea
- 2Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
- 3Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- 4Department of Neurology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
- 5Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
- 6Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
- 7Department of Neurology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
- 8Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 9Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
- 10Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
- 11Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
- 12Department of Neurology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
- 13Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- KMID: 2563833
- DOI: http://doi.org/10.59578/jmsni.2024.15.2.59-71
Abstract
- Background
Despite advances in treatment, 10-15% of the patients with myasthenia gravis (MG) are refractory to convention therapies, have severe disease, and are more likely to experience frequent clinical exacerbation. Although various new treatments have been developed, the evidence regarding their applicability to refractory MG remains unclear. Additionally, most of these new treatments are not yet available in Korea. Thus, we aimed to develop the consensus guidance regarding the management of patients with refractory MG.
Methods
The Korean Society of Neuroimmunology formed a task force consisting of 11 experts and adopted the RAND/UCLA appropriateness methodology to develop national consensus guidance for management of refractory MG. The standard therapy for MG was first defined. Following a thorough review of the literature, initial guidance statements on five key topics were developed. Two rounds of anonymous voting were conducted to reach consensus on the guidance statements, with modifications made based on panel input.
Results
Comprehensive guidance statements were developed covering definition, treatment goal and treatment of refractory MG. In addition, specific treatment strategies for acetylcholine receptor antibody-positive MG and muscle-specific tyrosine kinase antibody-positive MG were covered.
Conclusion
This guidance represents a national consensus of experts and was developed as a valuable resource for clinicians managing Korean adult patients with refractory MG.
