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First-line immunosuppression in neuromuscular diseases
  1. Michael A Foster1,2,
  2. Michael PT Lunn1,3,
  3. Aisling S Carr1,3
  1. 1UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
  2. 2Division of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
  3. 3Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
  1. Correspondence to Dr Michael A Foster, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, WC1E 6BT, UK; m.a.foster{at}ucl.ac.uk

Abstract

Autoimmune neuromuscular diseases are common and often treatable causes for peripheral nervous system dysfunction. If not optimally managed, they result in meaningful impairments and disability. The treating neurologist should aim to maximise clinical recovery with minimal iatrogenic risk. This requires careful patient and medication selection, appropriate counselling and close monitoring of clinical efficacy and safety. Here, we summarise our consensus departmental approach to first-line immunosuppression in neuromuscular diseases. We combine multispecialty evidence and expertise with a focus on autoimmune neuromuscular diseases to create guidance on starting, dosing and monitoring for toxic effects of the commonly used drugs. These include corticosteroids, steroid-sparing agents and cyclophosphamide. We also provide efficacy monitoring advice, as clinical response informs dosage and drug choice. The principles of this approach could be applied across much of the spectrum of immune-mediated neurological disorders where there is significant therapeutic crossover.

  • NEUROMUSCULAR
  • CLINICAL NEUROLOGY
  • NEUROPHARMACOLOGY

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

http://dx.doi.org/10.1136/pn-2023-003708

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    Data availability statement

    Data sharing not applicable as no datasets generated and/or analysed for this study.

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    Footnotes

    • Twitter @mike_the_nerve

    • Contributors MAF prepared the first draft of the manuscript. MPTL and ASC developed the topic for the article. All authors contributed to manuscript revisions, and all authors read and approved the submitted version.

    • Funding MAF is supported by a grant from the MRC (MR/S026088/1). MPTL and ASC are supported by the UCLH NHS Foundation Trust Biomedical Research Centre.

    • Competing interests None declared.

    • Provenance and peer review Commissioned. Externally peer reviewed by Jon Walters, Swansea, UK.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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