Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
Basic, Preventive and Clinical Sciences Department, Transilvania University, Brasov, Romania; and.
Am J Ther. 2021;28(6):e631-e637. doi: 10.1097/MJT.0000000000001454.
Advances in drug therapy for myasthenia gravis have had a significant impact on the quality of life and work potential of a substantial majority of affected persons and has contributed to a remarkable decrease in the frequency and severity of complications, hospitalizations, and mortality.
What are the milestones of the changes in the expert approach to the pharmacological management of myasthenia in the past century?
To determine the changes in the experts' approach to the management of myasthenia gravis, as presented in a widely used textbook in the United States.
The chapters presenting the management of myasthenia gravis in the 26 editions of Cecil Textbook of Medicine published from 1927 to 2020.
Adequate feeding, absolute rest in bed, and "tonics" were the only interventions recommended for the care of patients with myasthenia gravis in 1927. Ephedrine and glycine were used in the early 1930s. Treatment with the anticholinesterases physostigmine and neostigmine was recommended in 1937, 3 years after Mary Walker discovered it in the United Kingdom. Immunosuppressant pharmacological interventions with prednisone and azathioprine have been considered the standard since 1975, and intravenous immune globulin was added to usual care in 1996. The newer immunosuppressant drugs mycophenolate, cyclosporine, and tacrolimus have expanded the arsenal since 2008, and the monoclonal antibodies rituximab and eculizumab have been mentioned in the textbooks published in 2012-2020. The first randomized clinical trial of drug therapy for myasthenia gravis was published in 1987.
The pharmacological management of myasthenia gravis was revolutionized by the epiphany of an astute clinician in the 1930s. Immunosuppressant treatment was a logical step once the autoimmune nature of the condition was established. The major therapeutic advances highlight the values of empiricism and persistent attention to detail in treating relatively rare chronic disorders.
重症肌无力药物治疗的进步极大地改善了绝大多数患者的生活质量和工作能力，并显著降低了并发症、住院和死亡率的发生频率和严重程度。
在过去的一个世纪中，专家在重症肌无力药物治疗方法上的改变有哪些里程碑？
为了确定美国一本广泛使用的教科书中专家在重症肌无力管理方法上的改变。
1927 年至 2020 年出版的 Cecil 内科学 26 版中关于重症肌无力管理的章节。
1927 年，对于重症肌无力患者的护理，仅推荐充足的喂养、绝对卧床休息和“滋补品”。1930 年代早期使用了麻黄碱和甘氨酸。1937 年，Mary Walker 在英国发现了新斯的明，随后推荐使用抗胆堿酯酶药物 physostigmine 和 neostigmine 进行治疗。自 1975 年以来，免疫抑制剂药物泼尼松和硫唑嘌呤的药理学干预一直被认为是标准治疗方法，1996 年在常规治疗中加入了静脉注射免疫球蛋白。自 2008 年以来，新型免疫抑制剂药物霉酚酸酯、环孢素和他克莫司扩大了治疗选择，2012 年至 2020 年出版的教科书中提到了单克隆抗体利妥昔单抗和依库珠单抗。1987 年发表了首个重症肌无力药物治疗的随机临床试验。
20 世纪 30 年代一位敏锐的临床医生的顿悟彻底改变了重症肌无力的药物治疗方法。一旦确定了疾病的自身免疫性质，免疫抑制剂治疗就是合乎逻辑的下一步。这些主要的治疗进展突出了在治疗相对罕见的慢性疾病时注重经验主义和对细节的持续关注的重要价值。
