B12 Deficiency Neuropathy – Metformin-Induced — SCE Neurology MCQ

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HardPeripheral Neuropathy & NeuromuscularB12 Deficiency Neuropathy – Metformin-InducedSCE Neurology

A 41-year-old has AChR-antibody-positive generalised myasthenia gravis, MGFA class IIIa. Pyridostigmine, prednisolone and two steroid-sparing immunosuppressants have not provided adequate control; IVIg would otherwise be offered. Which newly recommended NHS add-on option most directly matches this scenario?

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Correct answer: A — Rozanolixizumab

A is correct: NICE TA1155 recommends the neonatal-Fc-receptor blocker rozanolixizumab as an add-on option for selected adults with AChR- or MuSK-antibody-positive generalised myasthenia gravis, MGFA class II–IVa, uncontrolled after at least two treatments other than acetylcholinesterase inhibitors, when IVIg or plasma exchange would otherwise be offered or has failed or is unsuitable. Efgartigimod was not recommended in TA1069. Ocrelizumab treats multiple sclerosis; satralizumab treats AQP4-positive NMOSD.

Reference: NICE TA1155: rozanolixizumab for treating antibody-positive generalised myasthenia gravis: https://www.nice.org.uk/guidance/ta1155/chapter/1-Recommendations