国际重症肌无力管理共识指南：2020 年更新版。
International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update.
机构信息
From the Beth Israel Deaconess Medical Center/Harvard Medical School (P.N.), Boston, MA; Department of Neurology (D.B.S., J.M.), Duke University Medical Center, Durham, NC; Department of Neurology (G.W.), Univ. at Buffalo Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY; Department of Neurology (M.B.), University of Miami, Miller School of Medicine. Miami, FL; Gabriel Cea (G.C.), Departamento de Ciencias Neurologicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile; Dipartimento di Neuroscienze (A.E.), Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy; Department of Clinical Medicine (N.E.G.), University of Bergen, Norway; Isabel Illa (I.I.), Department of Neurology, Hospital Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, ERN EURO-NMD and CIBERER U762, Spain; Departments of Pediatrics and Neurology (N.L.K.), Northwestern Feinberg School of Medicine, Chicago, IL; Neurology (A.M.), University of Tübingen Medical Centre, Tübingen, Germany; Department of Neurology (H.M.), International University of Health and Welfare, Narita, Japan; Department of Clinical Neurological Sciences (M.N.), Western University, London, ON, Canada; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK; Department of Neurology (D.R.), University of California, Davis, Davis, CA; and Department of Neurology (J.V.), Leiden University Medical Centre, Leiden, the Netherlands.
出版信息
Neurology. 2021 Jan 19;96(3):114-122. doi: 10.1212/WNL.0000000000011124. Epub 2020 Nov 3.
OBJECTIVE
To update the 2016 formal consensus-based guidance for the management of myasthenia gravis (MG) based on the latest evidence in the literature.
METHODS
In October 2013, the Myasthenia Gravis Foundation of America appointed a Task Force to develop treatment guidance for MG, and a panel of 15 international experts was convened. The RAND/UCLA appropriateness method was used to develop consensus recommendations pertaining to 7 treatment topics. In February 2019, the international panel was reconvened with the addition of one member to represent South America. All previous recommendations were reviewed for currency, and new consensus recommendations were developed on topics that required inclusion or updates based on the recent literature. Up to 3 rounds of anonymous e-mail votes were used to reach consensus, with modifications to recommendations between rounds based on the panel input. A simple majority vote (80% of panel members voting "yes") was used to approve minor changes in grammar and syntax to improve clarity.
RESULTS
The previous recommendations for thymectomy were updated. New recommendations were developed for the use of rituximab, eculizumab, and methotrexate as well as for the following topics: early immunosuppression in ocular MG and MG associated with immune checkpoint inhibitor treatment.
CONCLUSION
This updated formal consensus guidance of international MG experts, based on new evidence, provides recommendations to clinicians caring for patients with MG worldwide.
目的
根据文献中的最新证据，更新 2016 年关于重症肌无力（MG）管理的正式基于共识的指导。
方法
2013 年 10 月，美国重症肌无力基金会任命了一个工作组，为 MG 制定治疗指南，并召集了一个由 15 名国际专家组成的小组。使用 RAND/UCLA 适当性方法制定了与 7 个治疗主题相关的共识建议。2019 年 2 月，国际小组重新召开会议，增加了一名代表南美成员。审查了所有以前的建议的时效性，并根据最近的文献，在需要纳入或更新的主题上制定了新的共识建议。使用多达 3 轮匿名电子邮件投票来达成共识，并根据小组的意见对建议进行修改。使用简单多数票（80%的小组成员投票“是”）来批准语法和句法的细微更改，以提高清晰度。
结果
对胸腺切除术的先前建议进行了更新。针对利妥昔单抗、依库珠单抗和甲氨蝶呤的使用以及以下主题制定了新的建议：眼肌型 MG 的早期免疫抑制和免疫检查点抑制剂治疗相关的 MG。
结论
根据新证据，由国际 MG 专家制定的这一更新的正式共识指导为全球治疗 MG 患者的临床医生提供了建议。
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