Sami Khella, MD, explains the careful, gradual approach to corticosteroid initiation in myasthenia gravis, balancing the need for immunosuppression with the risk of temporarily worsening weakness.
Transcript
So corticosteroids, I love them and hate them. They’re a double-edged sword. My typical approach with corticosteroids is to ramp up quickly, but gingerly, if you will.
The reason is that if you go from 0.1 mg/kg, say 5 or 10 mg a day, to 60 within 2 or 3 days, you will make that patient weaker because the steroids actually block the neuromuscular junction, the acetylcholine receptor. They are physical blockers. So before they are able to induce immunosuppression, they will have blocked the receptor and made the patient weaker.
So what I typically do is start, depending on how sick the patient is, with 5 or 10 mg at a time, and then bump up every 2 or 3 days by 5 or 10 mg on the outpatient side of things.
