マラソンレクチャー
重症筋無力症の治療 最近の動向
キーワード:
myasthenia gravis (MG),
generalized MG,
ocular MG,
early fast–acting treatment strategy,
molecular target drug
2021 年 38 巻 4 号 p. 446-448
詳細
2021 年 38 巻 4 号 p. 446-448
In the 1970s and 1990s, thymectomy and high–dose oral prednisolone (PSL) were the only treatment options for myasthenia gravis (MG). Immunosuppressive agents and intravenous immunoglobulin therapy for MG were introduced in 2000. In 2016, a randomized controlled trial was conducted to evaluate the efficacy of thymectomy in non–thymoma patients, and the treatment was found to be effective in patients with acetylcholine receptor (AChR) antibody–positive early onset MG. In 2017, eculizumab, a component C5 inhibitor, was introduced for AChR antibody–positive refractory patients who relapse despite standard therapy. New molecularly targeted agents for MG are under development and clinical trials. However, the remission rate of MG remains low, and treatment is aimed at improving patients' quality of life (QOL). To maximize QOL improvement, PSL use should be minimized. Early treatment with a combination of plasmapheresis, intravenous methylprednisolone therapy, and immunosuppressive drugs is the fastest and most effective way to achieve good QOL and is recommended for the treatment of generalized MG.
