Steroids have an important role

The natural history of MG demonstrates that most patients need treatment beyond cholinesterase inhibitors. Thymectomy is not appropriate for all patients and often results in partial or delayed improvement that requires long-term immunosuppression. PE and IVIg are too expensive for long-term management. Azathioprine and cyclosporine have not been shown to be more efficacious than steroids, have potential side effects that are as serious as those of steroids, and are considerably more expensive. Other immunosuppressives appear promising, but are early in their development. Thus, steroids remain an important part of MG management. The lack of standardized outcome measures and direct comparison studies make it difficult to determine the "best" treatment for MG. Attention has recently been directed toward developing disease-specific outcome measures11 that should facilitate comparisons of future cohorts and promote head-to-head clinical trials.