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Generalised MG Treatment — RACP Adult Medicine MCQ

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ModerateNeurologyGeneralised MG TreatmentRACP Adult Medicine

A 30-year-old woman with newly diagnosed generalised MG (anti-AChR positive) has moderate symptoms (MG-ADL score 8). CT shows no thymoma. She is on pyridostigmine 60 mg QID with incomplete symptom control. What is the most appropriate next step?

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Correct answer: E — Add prednisolone plus azathioprine

Generalised MG with incomplete response to pyridostigmine requires immunosuppressive therapy. Standard approach: prednisolone (start low, titrate up) plus azathioprine (steroid-sparing agent, takes 6-12 months for full effect). Prednisolone provides rapid benefit while awaiting azathioprine effect. Thymectomy should also be considered for anti-AChR positive generalised MG (MGTX trial: benefit even without thymoma).

Reference: eTG Neurology – 2024 – MG; AANEM/MG Foundation 2024