Evidence base: Myasthenia gravis

A summary of the clinical trials, guidelines, key texts and online resources to help in the management of Myasthenia gravis

Patient with signs of upper eyelid and facial weakness (Photograph: SPL)
Patient with signs of upper eyelid and facial weakness (Photograph: SPL)

Clinical trials

Unfortunately there are relatively few good drug treatment trials in MG.

This was a review of the use of corticosteroids.

  • Palace J, Newsom-Davis J, Lecky B. A randomised double-blind trial of prednisolone alone or with azathioprine in myasthenia gravis. Myasthenia Gravis Study Group. Neurology 1998; 50(6): 1778-83.6

This was the only trial to convincingly show an effect of a second-line agent

  • Benatar M, Rowland LP.

The muddle of mycophenolate mofetil in myasthenia. Neurology 2008; 71: 390-1.7

This review stated that trials of mycophenolate mofetil produced unclear results

  • The MGTX study is an international trial of the use of thymectomy with the primary outcome being reduction in steroid dose. This trial has been ongoing for five years and recruitment continues.


There are no NICE or SIGN guidelines on myasthenia.

Key text

There are many neurology textbooks MG but the best source of further information is review articles from specialist centres for example.

  • Hilton-Jones D and Palace J. The management of myasthenia gravis. Pract Neurol 2005; 5: 18-27.


The Myasthenia Gravis Association website has information for both patients and medical professionals.

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