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MANAGEMENT OF MYASTHENIA GRAVIS COMPARED TO NATIONAL GUIDELINES 
  1. Pulukkuttiralalage Senali Perera1,
  2. May Yung Tiet2,
  3. Saiju Jacob2
  1. 1 University of Birmingham
  2. 2 University Hospital of Birmingham

Abstract

Background Myasthenia Gravis (MG) is an autoimmune disorder presenting with fatigable muscle weakness leading to potential respiratory distress. Clinical management aims to improve patient quality of life and prevent acute admission, whilst minimising the side effect profile of medications.

Aims This audit evaluated the management of MG according to the national guidelines

We reviewed:

▸ Pyridostigmine and immunosuppression dose escalation protocols

▸ Adequate prophylactic treatment with proton pump inhibitors and bone protection

▸ Thiopurine methyltransferase (TPMT) levels assessment prior to commencing Azathioprine.

Methods 69 MG patients (clear clinical picture of MG with positive AChR/MuSK antibodies) diagnosed between 2010–2014 were included. Clinic and discharge letters were retrospectively analysed and compared against the national guidelines set by the MG Specialist Interest Group.

Results Pyridostigmine and steroids were appropriately prescribed and escalated in 76.1% and 92.3% of patients respectively. 90% of patients on steroids received adequate bone protection and 82% received proton pump inhibitors. 71.4% of patients on Azathioprine had a documented normal TPMT level prior to commencing treatment.

Conclusion Management of MG patients at UHB in general comply with national guidelines. However, variations in practice were noted for once or alternate day steroid usage and also regarding reduction or withdrawal of Pyridostigmine.

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