Myasthenia gravis is one of the oldest recognized autoimmune neurologic diseases, but practice-changing clinical trials remain challenging despite greater knowledge of pathophysiology. Both incidence and prevalence of the disease have increased over the years because of greater awareness of MG, better application of diagnostic testing, and better quality of epidemiologic studies. Corticosteroids were introduced as treatment for MG in the 1950s but took 2 years to become a mainstay of treatment, after observing that a proportion of patients experienced subsequent improvements in weakness after an initial transient deterioration. More recently, advancing science and drug development methods such as monoclonal antibody development has yielded signal advances in the treatment of MG, including FcRN inhibitors, complement inhibitors, B- and T-cell inhibitors, and stem cell transplantation. These advances notwithstanding, even though they hold promise as steroid-reducing strategies—have not changed the overall landscape of MG therapy, especially outside of highly specialized treatment centers. In general, treatment with oral corticosteroids at high doses with an escalation and de-escalation schedule is effective against MG, and has led to a reduction in mortality to below 10% since the 1960s, and is entrenched in the foundational care of gMG. For as long as pharmacologic steroid therapy has been available, however, the toxicity of its high-dose and long-term use has been recognized. Now that new and emerging non-steroid gMG therapies are becoming more widely available, it is essential to improved outcomes and patient quality of life (QoL) for clinicians to recognize earlier and more consistently the adverse effects of glucocorticoid therapy so that it can be ameliorated with new therapy or co-therapy that reduces steroid exposure.
MG and other neuromuscular disease specialists, neuroimmunologists, general neurologists, other physicians, specialty and hospital pharmacists, and NPs and PAs who manage patients with MG. The program is designed to reach targeted learners in both academic and community practice settings.
- Recognize the underlying pathophysiology and potential therapeutic targets in gMG
- Recognize the adverse effects related to glucocorticoid therapy for which patients on steroids for gMG are at risk
- Understand the utility of standardized and validated QoL tools that allow systematic and consistent evaluation of the adverse effects of glucocorticoid therapy in patients with gMG, and develop a standardized patient assessment for incorporation into the clinic’s ongoing care approach
- Critically evaluate the clinical trial data supporting new and emerging steroid-sparing therapies for gMG and apply those data to appropriate and evidence-based patient selection for newer, steroid-sparing gMG therapies
James F. Howard, Jr., MD
Professor of Neurology, Medicine & Allied Health
Department of Neurology
The University of North Carolina at Chapel Hill
Professor of Clinical Sciences (Neurology)
Department of Clinical Science (Neurology)
North Carolina State College of Veterinary Medicine
Chapel Hill, NC
Disclosures of Relevant Financial Relationships
It is the policy of AcademicCME that all faculty, instructors, and planners disclose relevant financial relationships relating to the topics of this educational activity. Any relevant financial relationships are mitigated via a content review by planning committee members and faculty with no relevant financial relationships.
The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CE activity:
|Relationship Identified With:
|James F. Howard, Jr., MD
|Consultant/Advisor: Alexion Pharmaceuticals; argenX; Avilar; F. Hoffman LaRoche; Immunovant; Merck EMD; NMD Pharma; Novartis; Ra Pharma (now UCB); Regeneron; Sanofi; Seismic Therapeutics; Viela Bio, Inc. (now Horizon Therapeutics)
Research/Support: argenX; Cartesian Therapeutics; CDC; Duke Research; NIH (NINDS NIAMS, RDCRN-MGNet); PCORI; Ra Pharma (now UCB); Takeda; Viela Bio, Inc. (now Horizon Therapeutics)
|John H. Stone, MD, MPH
|Consultant/Advisor: Amgen; argenX; AbbVie; Bristol Myers Squibb; Connect Biopharma; Genentech; Horizon Therapeutics; IQVIA; Novartis; PPD; Prometheus; Q32; Sanofi
Research Support: Bristol Myers Squibb; Horizon Therapeutics; Sanofi
Planners and Peer Reviewers
Timothy Hayes, MD, PhD; Kim Cheramie, MSN, RN-BC; Chelsey Simonds and Nicole McMenamin hereby state that they or their spouse/life partner do not have any relevant financial relationships to products or devices with any commercial interests related to the content of this activity of any amount during the past 12 months.
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AcademicCME designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM.
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This activity has been supported by an independent educational grant from argenX.
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