There is no cure, but MG is treatable and many patients live active lives with proper care.
Treatments and Medications Available in Singapore
Although MG has no cure, effective treatments are widely available in Singapore, particularly through the public healthcare system.
First-Line Symptomatic Treatment
Pyridostigmine
- Most commonly prescribed medication for MG
- Improves communication between nerves and muscles
- Helps reduce weakness and fatigue
This medication is routinely prescribed in Singapore public hospitals.
Immunosuppressive Treatments
Corticosteroids (e.g. Prednisolone)
- Used to reduce autoimmune activity
- Often effective but monitored closely due to side effects. In public hospitals, you will be closely monitored by the endocrine and ophthalmology departments. You are likely to be issued calcium and vitamin D supplements to negate the side effects.
Steroid-Sparing Immunosuppressants (e.g. Mycophenolate mofetil, Azathioprine)
- Used for long-term disease control
- Can take up to 6 months for effects to kick in
- Require regular blood monitoring
Advanced Therapies (For Severe or Unstable MG that does not respond well to oral medications)
Intravenous Immunoglobulin (IVIG)
- Used during severe exacerbations or myasthenic crisis
- May also be used before a Thymectomy to better stabilise a patient ahead of the surgery
Plasmapheresis
- Removes harmful antibodies from the blood
- Used in life-threatening or rapidly worsening cases
Rituximab Infusion
- Used off-label for treating MG by depleting the B-cells
- Known to improve clinical status, reduces steroid doses, and long-term remission is possible.
- However, it increases one’s risk of infection.
- Some patients are also unable to undergo this when their blood counts are reduced drastically from the infusion.
There are several medications specifically targeting MG. Unfortunately, many of these drugs are either not yet approved for use in Singapore or are not subsidized for patients.
Surgical Treatment
Thymectomy
- Surgical removal of the thymus gland
- Considered for selected patients, especially those with thymoma and an enlarged thymus
- Performed in major Singapore hospitals with neurology and thoracic surgery teams
- Generally, not recommended for patients exceeding 60 years old.