Tratamento da miastenia grave mediante imunossupressão medicamentosa não esteróide

Abstract

Fourteen patients (twelve of them were women) with severe myasthenia gravis who had not responded to any treatment at all, were treated by cytostatic drugs. Both azathioprine and cyclophosphamide single or in combination are used. All patients except two were thymectomized and almost all were treated by plasmapheresis and corticosteroid before and during the cytostatic treatment. All patients take cholinesterase inhibitors. No serious complications were observed. The patients received 100-200mg of azathioprine and/or 100-200mg of cyclophosphamide daily by oral route, the first during 20 months and the second one during 6 months. Three patients received cyclophosphamide 1g daily by venous route during 6 months at 15-20 days intervals. The preliminary results were favourable occurring important improvement in 71.4% of the cases. Their performance increased considerably. The progress of the disease was generally stabilized. Exacerbations and crises did not recur, except in one case. Only three patients had not responded to the treatment, one responded poorly but better later and one had an exacerbation after the 24th month. This patient returned to azathioprine.

História do estudo da miastenia grave na clínica neurológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

“…A partir de 1980 foram estudadas na CNHCFMUSP terapias novas de base etiopatogênica, devendo ser destacados a plasmaférese e o emprego das drogas citolíticas para imunossupressão medicamentosa não esteróide 9 .…”

“…A imunossupressão medicamentosa não esteróide realizada com as drogas citolíticas, empregada em raros pacientes (de regra timomatosos) nas décadas de 50 e 60, passou a ser usada em rotina, embora em menor número de miastênicos, timomatosos ou não e que respondiam pobremente aos demais tratamentos 9,303 . O número de pacientes assim tratados vem crescendo nos últimos anos, chegando a 57 em 1992.…”