Myasthenia gravis is a rare autoimmune disorder that belongs to the group of neuromuscular junction disorders. The recent studies on this disease have presented a lot of data regarding the causes of the disorder, diagnosing, treatment, and possible prognosis for further achievements in this field. The purpose of this systematic literature review is to report the latest findings regarding the causes and diagnosis of myasthenia gravis and evaluate the proposed treatment options.
Two studies were selected for review with the focus on such including criteria as the presentation of information from observational and controlled studies, the discussion of causes, diagnosing, and treatment, and the focus on the prognosis. Studies published earlier than within the past five years were excluded from the search. In their study, Gilhus and Verschuuren (2015) have focused on presenting the classification of myasthenia gravis subgroups and assessing available treatment options and interventions appropriate for these subgroups. Iorio, Damato, Alboini, and Evoli (2015) have conducted a meta-analysis in order to discover how myasthenia gravis can be treated with the help of rituximab.
The researchers state that the particular causes of myasthenia gravis are pathogenic antibodies that act against specific postsynaptic proteins of the muscle endplate or membrane (Gilhus & Verschuuren, 2015; Iorio et al., 2015). Different types of antigens are associated with changes in the neuromuscular junction and the associated muscle weakness, which severity can also be different. The researchers also note that myasthenia gravis is diagnosed with a focus on this muscle weakness and its localization (Iorio et al., 2015). The disease usually affects extraocular, limb, bulbar, and axial muscles, and the weakness can be both symmetrical and asymmetrical (Gilhus & Verschuuren, 2015; Iorio et al., 2015). Gilhus and Verschuuren (2015) have determined seven myasthenia gravis subgroups depending on the discussed symptoms which differ in terms of antibodies and proteins associated with the development of this disorder, and the analysis of the related causes is more detailed in this work than in the study by Iorio et al. (2015).
Both studies present a thorough discussion of treatment options. However, if Gilhus and Verschuuren (2015) have focused on classifying therapies as symptomatic drug treatment, immunosuppressive drug treatment, thymectomy, and supportive treatment, Iorio et al. (2015) have presented the complex analysis of the use of rituximab in contrast to immunotherapy. According to Gilhus and Verschuuren (2015), the selection of the most appropriate treatment depends on myasthenia gravis subgroups, and the effectiveness is based on the long-term consumption of selected drugs and the use of acetylcholinesterase inhibitors. In their study, Iorio et al. (2015) have found that rituximab is more appropriate to be used in patients with MuSK-Ab MG, and its effect on patients with AChR-Ab MG is not significant. The prognosis of the authors of both studies is that drug therapy based on the use of rituximab, eculizumab, belimumab, and etanercept will have more positive effects on patients than the traditional immunotherapy. These conclusions are evidence-based and supported by the studies’ results.
The systematic review of the two studies on myasthenia gravis has indicated that, currently, health care practitioners refer to different subgroups of the disorder while diagnosing the problem. The treatment is prescribed depending on the type and severity of myasthenia gravis. Nowadays, a variety of drug therapies can be proposed to patients in contrast to the use of immunotherapy, which has many adverse effects. However, the further question for researching is whether different drug therapies are more effective in comparison to immunotherapy with reference to the most severe cases.
References
Gilhus, N. E., & Verschuuren, J. J. (2015). Myasthenia gravis: Subgroup classification and therapeutic strategies. The Lancet Neurology, 14(10), 1023-1036.
Iorio, R., Damato, V., Alboini, P. E., & Evoli, A. (2015). Efficacy and safety of rituximab for myasthenia gravis: A systematic review and meta-analysis. Journal of Neurology, 262(5), 1115-1119.