Azathioprine and mycophenolate mofetil in myasthenia gravis

The inclusion of participants with less severe disease (as shown by the low hospital admissions, low mean baseline Myasthenia Gravis-Activities of Daily Living scores, and the low incidence of comorbidities) suggests a possible selection bias. People with seronegative myasthenia gravis were not included, and although this subgroup comprises a small proportion of people with myasthenia gravis, these individuals can present a significant clinical challenge, particularly for therapeutic management.2 Additionally, individuals who were taking or had previously taken corticosteroids in the 30 days preceding the initial assessment were excluded.3 In our opinion, this exclusion criterion might not accurately reflect the clinical need or usefulness of immunosuppressive drugs such as azathioprine and mycophenolate mofetil, which are specifically prescribed to reduce the use of corticosteroids. [...]these new drugs have a further potential as rescue therapies.4,5 A more thorough exploration of the role of these therapies within the context of myasthenia gravis treatment algorithms would have been informative.