[Treatment of XXXX : role of corticoids and immunosuppressive agents].

@entity1 @entity500 @entity75 @entity1737 @entity1282 @entity792 @entity288
OPTIMAL TREATMENT: @entity1737 is an @entity792 related to a recognized autoantigen. Treatment is aimed at providing symptomatic relief or a pathophysiological effect. The latter approach, with corticosteroid and immunosuppressor regimens, has proven to be effective, improving functional improvement, but at the cost of prolonged treatment over several years with the risk of major adverse effects. Indications and treatment modalities must be carefully weighed. INITIATING TREATMENT: The question is when to start @entity288 or immunosuppressors. A regimen should be initiated when, after all aggravating factors have been eliminated, a well-conducted anticholinesterase treatment remains ineffective with persistent major muscular @entity75 ( @entity1282 , ventilation). @entity288 and immunosuppressors are also indicated if acute episodes occur, even if they regress. TREATMENT REGIMENS: To date, no controlled study has validated any particular therapeutic protocol. Both @entity288 and immunosuppressors are known to provide major improvement in 80% of @entity1 . No one immunosuppressor has been found to be more effective, but @entity500 is prescribed preferentially because of its lower profile of adverse effects. IN CLINICAL PRACTICE: Response is relatively rapid to @entity288 which are recommended in combination with @entity500 at treatment onset for more severe cases (brain stem signs or recurrent acute episodes) or secondarily in case of resistance to moderate dose @entity288 . In all cases, treatment must be prolonged for several years. Relapses are frequent after treatment withdrawal.
