In patients with thymoma there is no HLA association. Although no direct link has been found, this HLA association, along with the fact the MG patients have a higher incidence of other autoimmune diseases, suggests an inherited defect in immune regulation. Treatment Management of MG is primarily pharmacological. The goal of treatment is remission, which can be achieved in about a third of cases. The remaining cases require ongoing medical treatment to keep the disease under control.
Some cases remain poorly controlled despite maximal medical treatment.
Mestinon is an acetylcholinesterase inhibitor, just like edrophonium but longer acting. Mestinon increases availability of ACh at the receptor site, thereby increasing strength. This is considered symptomatic treatment only, since it does not affect the underlying cause or course of the disease. The usual maximum dose is 60mg q4 hours and the typical starting dose is 30mg q6 hours. Chronic high doses should be avoided, by giving drug holidays if necessary.