SPECIFIC MEDICATIONS

• Corticosteroids (Prednisone or Solumedrol) are used for long-term immunosuppression.
  There is relatively rapid onset of benefit (Months).
  Side effects are common.
  
• Cyclosporine A is an alternative to Prednisone for long-term immunosuppression.
  There is relatively rapid onset of benefit (Months).
  In doses used for neuromuscular disorders side effects are not common.
• Azathioprine provides long-term immunosuppression with relatively few side effects.
  It may be useful to reduce needed doses of corticosteroids.
  There may be a long latency before benefit begins.
  Some patients do not improve at all.
• Mycophenolate mofetil may be used as a substitute for azathioprine.
  It may be useful to reduce needed doses of corticosteroids.
  There may be a long latency before benefit begins.
  
• Methotrexate can have a relatively rapid onset of benefit (Months).
  It can be useful when corticosteroids or Cyclosporine A are ineffective or contraindicated.
  With routine monitoring, serious side effects are uncommon.
  
• Cyclophosphamide is useful in immune disorders with life threatening features
  and in B-cell mediated disorders that respond to few other treatments.
  As it has serious side effects, cyclophosphamide should be considered a treatment of last resort.
• Plasma exchange (PE) and Human immune globulin (IVIg or SQ) are used for rapid onset, short-term benefit
  when patients have life-threatening signs such as respiratory insufficiency, dysphagia, or severe weakness.
  They are the only treatments shown to be of benefit in Guillain-Barré syndrome.
  PE & IVIg are expensive but are occasionally used for chronic therapy when other treatments have failed.
  
• Rituximab may be useful in NM disorders with associated serum IgM or IgG₄ autoantibodies.
  Over the short term Rituxan appears to have few side effects.