International Consensus Guidance for Management of Myasthenia Gravis 2020 Update
Por:
Narayanaswami, P, Sanders, DB, Wolfe, G, Benatar, M, Cea, G, Evoli, A, Gilhus, NE, Illa, I, Kuntz, NL, Massey, J, Melms, A, Murai, H, Nicolle, M, Palace, J, Richman, D, Verschuuren, J
Publicada:
19 ene 2021
Resumen:
Objective
To update the 2016 formal consensus-based guidance for the management of myasthenia gravis (MG) based on the latest evidence in the literature.
Methods
In October 2013, the Myasthenia Gravis Foundation of America appointed a Task Force to develop treatment guidance for MG, and a panel of 15 international experts was convened. The RAND/UCLA appropriateness method was used to develop consensus recommendations pertaining to 7 treatment topics. In February 2019, the international panel was reconvened with the addition of one member to represent South America. All previous recommendations were reviewed for currency, and new consensus recommendations were developed on topics that required inclusion or updates based on the recent literature. Up to 3 rounds of anonymous e-mail votes were used to reach consensus, with modifications to recommendations between rounds based on the panel input. A simple majority vote (80% of panel members voting "yes") was used to approve minor changes in grammar and syntax to improve clarity.
Results
The previous recommendations for thymectomy were updated. New recommendations were developed for the use of rituximab, eculizumab, and methotrexate as well as for the following topics: early immunosuppression in ocular MG and MG associated with immune checkpoint inhibitor treatment.
Conclusion
This updated formal consensus guidance of international MG experts, based on new evidence, provides recommendations to clinicians caring for patients with MG worldwide.
Filiaciones:
Narayanaswami, P:
Harvard Med Sch, Beth Israel Deaconess Med Ctr, Boston, MA 02115 USA
Sanders, DB:
Duke Univ, Med Ctr, Dept Neurol, Durham, NC USA
Wolfe, G:
SUNY Buffalo, Dept Neurol, Jacobs Sch Med & Biomed Sci, Buffalo, NY USA
Benatar, M:
Univ Miami, Miller Sch Med, Dept Neurol, Miami, FL 33136 USA
Cea, G:
Univ Chile, Dept Ciencias Neurol, Fac Med, Santiago, Chile
Evoli, A:
Univ Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli IRCCS, Dipartimento Neurosci, Rome, Italy
Gilhus, NE:
Univ Bergen, Dept Clin Med, Bergen, Norway
Illa, I:
Univ Autonoma Barcelona, Dept Neurol, Hosp Santa Creu & St Pau, ERN EURO NMD & CIBERER,U762, Barcelona, Spain
Kuntz, NL:
Northwestern Feinberg Sch Med, Dept Pediat, Chicago, IL USA
Northwestern Feinberg Sch Med, Dept Neurol, Chicago, IL USA
Massey, J:
Duke Univ, Med Ctr, Dept Neurol, Durham, NC USA
Melms, A:
Univ Tubingen, Med Ctr, Neurol, Tubingen, Germany
Murai, H:
Int Univ Hlth & Welf, Dept Neurol, Narita, Japan
Nicolle, M:
Western Univ, Dept Clin Neurol Sci, London, ON, Canada
Palace, J:
Oxford Univ Hosp Trust, John Radcliffe Hosp, Dept Clin Neurol, Oxford, England
Richman, D:
Univ Calif Davis, Dept Neurol, Davis, CA 95616 USA
Verschuuren, J:
Leiden Univ, Med Ctr, Dept Neurol, Leiden, Netherlands
Green Published, Green Submitted, hybrid
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