When do you consider complement inhibitors or FcRN inhibitors in patients with myasthenia gravis?

In my opinion, those meds should be considered for a patient with AchR antibody-positive MG who has suboptimal control of MG symptoms on:

1. Pyridostigmine + prednisone + oral immunosuppressant drugs like azathioprine or MMF.
2. Pyridostigmine + oral immunosuppressant + severe intolerance to steroids (side effects) or dependence (unable to taper prednisone dose below 15-20 mg daily despite taking non-steroidal immunosuppressants).

Some of my colleagues may argue that FCRN and complement inhibitor dr...

In theory, I agree with Dr. @Dr. First Last but for me, the answer is more complicated.

MMF and aza usually take many months to kick in, and it is not particularly useful to get the disease under control quickly. The concept that they should be used as "steroid-sparing agents" is good but one does add on their risks on top of the steroids for several months until one actually gets the patient off steroids.

We all acknowledge the effectiveness of steroids, but would you consider using them in an ...