International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update

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 seven treatment topics. In February 2019, the international panel was reconvened with the addition of one member to represent South America. All prior recommendations were reviewed for currency, and new consensus recommendations were developed on topics that required inclusion or updates based on recent literature. Up to three rounds of anonymous e-mail votes were used to reach consensus, with modifications to recommendations between rounds based on 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.

Accepted
Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Conclusion
This updated formal consensus guidance of international MG experts, based on new evidence, provides recommendations to clinicians caring for MG patients worldwide.