Benefits from sustained-release pyridostigmine bromide in myasthenia gravis: Results of a prospective multicenter open-label trial

Sieb, J. P.; Köhler, Wolfgang

doi:10.1016/j.clineuro.2010.06.018

Cited by 17 publications

(10 citation statements)

References 9 publications

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“…PB is available as: ○ An oral standard tablet, dose 60 mg; this is the most commonly used preparation.○ A sustained-release preparation (180 mg);24 usually prescribed at bedtime for patients symptomatic during the night or in the early morning. A switch from instant to sustained-release PB as been proposed but still not fully investigated 24…”

Section: Drugs Improving Neuromuscular Transmissionmentioning

confidence: 99%

Current and emerging therapies for the treatment of myasthenia gravis

Mantegazza

Bonanno²,

Camera³

et al. 2011

NDT

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Myasthenia gravis (MG) is an autoimmmune disease in which autoantibodies to different antigens of the neuromuscular junction cause the typical weakness and fatigability. Treatment includes anticholinesterase drugs, immunosuppression, immunomodulation, and thymectomy. The autoimmune response is maintained under control by corticosteroids frequently associated with immunosuppressive drugs, with improvement in the majority of patients. In case of acute exacerbations with bulbar symptoms or repeated relapses, modulation of autoantibody activity by plasmapheresis or intravenous immunoglobulins provides rapid improvement. Recently, techniques removing only circulating immunoglobulins have been developed for the chronic management of treatment-resistant patients. The rationale for thymectomy relies on the central role of the thymus. Despite the lack of controlled studies, thymectomy is recommended as an option to improve the clinical outcome or promote complete remission. New videothoracoscopic techniques have been developed to offer the maximal surgical approach with the minimal invasiveness and hence patient tolerability. The use of biological drugs such as anti-CD20 antibodies is still limited but promising. Studies performed in the animal model of MG demonstrated that several more selective or antigen-specific approaches, ranging from mucosal tolerization to inhibition of complement activity or cellular therapy, might be feasible. Investigation of the transfer of these therapeutic approaches to the human disease will be the challenge for the future.

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Section: Drugs Improving Neuromuscular Transmissionmentioning

confidence: 99%

Current and emerging therapies for the treatment of myasthenia gravis

Mantegazza

Bonanno²,

Camera³

et al. 2011

NDT

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“…The results of an open-label multicenter clinical study support the usefulness of a sustained-release preparation of pyridostigmine to improve quality of life for patients with myasthenia gravis. 6 The in vitro release characteristics of other modifiedrelease formulations of pyridostigmine reported previously (microparticles, pellets, and hydroxypropylmethylcellulosebased sustained-release tablet) are similar to those of Timespan. 7,8 Other approaches, including nanosized poly(lactic acid) (PLA) particles, are receiving attention 9,10 in an effort to improve such sustained-release drug formulations further.…”

Section: Introductionmentioning

confidence: 60%

Nanosized sustained-release pyridostigmine bromide microcapsules: process optimization and evaluation of characteristics

Tan¹,

Jiang²,

Xu³

et al. 2013

IJN

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Background: Pyridostigmine bromide (3-[[(dimethylamino)-carbonyl]oxy]-1-methylpyridinium bromide), a reversible inhibitor of cholinesterase, is given orally in tablet form, and a treatment schedule of multiple daily doses is recommended for adult patients. Nanotechnology was used in this study to develop an alternative sustained-release delivery system for pyridostigmine, a synthetic drug with high solubility and poor oral bioavailability, hence a Class III drug according to the Biopharmaceutics Classification System. Novel nanosized pyridostigmine-poly(lactic acid) microcapsules (PPNMCs) were expected to have a longer duration of action than free pyridostigmine and previously reported sustained-release formulations of pyridostigmine. Methods: The PPNMCs were prepared using a double emulsion-solvent evaporation method to achieve sustained-release characteristics for pyridostigmine. The preparation process for the PPNMCs was optimized by single-factor experiments. The size distribution, zeta potential, and sustained-release behavior were evaluated in different types of release medium. Results: The optimal volume ratio of inner phase to external phase, poly(lactic acid) concentration, polyvinyl alcohol concentration, and amount of pyridostigmine were 1:10, 6%, 3% and 40 mg, respectively. The negatively charged PPNMCs had an average particle size of 937.9 nm. Compared with free pyridostigmine, PPNMCs showed an initial burst release and a subsequent very slow release in vitro. The release profiles for the PPNMCs in four different types of dissolution medium were fitted to the Ritger-Peppas and Weibull models. The similarity between pairs of dissolution profiles for the PPNMCs in different types of medium was statistically significant, and the difference between the release curves for PPNMCs and free pyridostigmine was also statistically significant. Conclusion: PPNMCs prepared by the optimized protocol described here were in the nanometer range and had good uniformity, with significantly slower pyridostigmine release than from free pyridostigmine. This novel sustained-release delivery nanosystem for pyridostigmine might alleviate the need to identify new acetylcholinesterase inhibitors.

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“…Patients with MG treated with AChR inhibitors, who have reactive airway disease, may have worsening of respiratory function secondary increased respiratory secretions leading to a false conclusion that respiratory insufficiency is caused by myasthenic weakness. An open label prospective trial demonstrated improved quality of life with the sustained-release form of pyridostigmine, which requires less frequent administration (Sieb and Kohler 2010). However, in the author's experience, more reliable improvements in strength occur with the standard preparation.…”

Section: Acetylcholesterase Inhibitionmentioning

confidence: 99%