Celebrating the 70 years of pyridostigmine on therapy of Myasthenia Gravis: historical aspects of the preliminary trials

LORENZONI, Paulo José; KAY, Cláudia Suemi Kamoi; DUCCI, Renata Dal-Prá; FUSTES, Otto Jesus Hernandez; WERNECK, Lineu Cesar; SCOLA, Rosana Herminia

doi:10.1590/0004-282X20190189

Brasil

home Sumário navigate_before Anterior Atual Seguinte navigate_next

home Sumário

Historical Note • Arq. Neuro-Psiquiatr. 78 (3) • Mar 2020 • https://doi.org/10.1590/0004-282X20190189 linkcopy

Celebrating the 70 years of pyridostigmine on therapy of Myasthenia Gravis: historical aspects of the preliminary trials

Celebrando os 70 anos da piridostigmina no tratamento da Miastenia Gravis: aspectos históricos dos ensaios clínicos preliminares

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Currently, pyridostigmine bromide is an indispensable anticholinesterase agent used worldwide to treat patients with Myasthenia Gravis (MG). However, pyridostigmine bromide was unsuccessful in its “pioneering trials” to treat a series of MG patients. There are important historical landmarks before pyridostigmine bromide becomes useful, safe and indispensable for MG therapy. After 70 years of these “pioneering trials”, this article reviews some historical aspects related to them, as well as other preliminary trials using pyridostigmine bromide as therapy for MG patients.

Keywords: myasthenia gravis; pyridostigmine; treatment; history

Author, year (Original Language^#)	(n) ^##	Outcome
Tether, 1947⁷ (English)	6	The “results were equivocal” with the exception that there were fewer reactions than with neostigmine. However, a low dosage of pyridostigmine was used (30 mg). This “trial” was only cited in 1954.⁷
Schwab et al., 1948⁵ (English)	10	No better than neostigmine. No unfavorable adverse event. The pyridostigmine dosage was the same of the neostigmine. This “trial” was only cited in 1954.⁵
Welte, 1953¹⁴ (German)	5	Pyridostigmine had advantages over a previous treatment with neostigmine: first and foremost, it was more effective and tolerated with no side effects, especially in high doses; and, second, also had a prolonged duration of its effect with physical rest.
Seibert, 1953¹⁰ (German)	23	Favorable experience. The effect is more intense and lasts longer. Side effects only occur rarely on and keep within tolerable limits. Therapy started in 1948 for some patients.
Bauer et al., 1953³ (German)	5	The longest duration of the action offered one advantage over neostigmine. The good tolerability of the drug allowed an increase in the required amount without the threat of side effects. Experimental pharmacological tests, comparing neostigmine and pyridostigmine, on the phrenic diaphragmatic nerve and on the masticatory muscles of the rat supplemented clinical observations.
Struppler, 1953¹¹ (German)	20	The effects of pyridostigmine were indicated by examples (reported in few patients) based on clinical and experimental observations. Pyridostigmine was enough to make the patient adequately treated, but the optimal effect was reached only after about 1 hour (greater latency than for neostigmine).
Schwab et al., 1954⁵ (English)	50	20 patients found the drug superior to neostigmine. “Large” individual doses were used. The “antimyasthenic effect” was calculated as one fourth of the equivalent amount of neostigmine.
Osserman et al., 1954⁶ (English)	20	15 patients found pyridostigmine more effective than neostigmine. Side-reactions were absent or so diminished that the use of atropine could be stopped.
Westberg et al., 1954⁸ (English)	22	21 patients preferred pyridostigmine over neostigmine. The duration and maintenance of effect was longer. Side effects were mild.
Tether, 1954⁷ (English)	56	Neostigmine and pyridostigmine provided relatively equal control of “myasthenic symptoms.” Pyridostigmine provides smoother and a more sustained control of symptoms. Untoward reactions are less frequent and less intense. No toxicity was noted. Pyridostigmine was less desirable than neostigmine, because it has a slower onset of action.

vertical_align_top file_download show_chart

more_horizclose
- image
- translate
- link
- article
- vertical_align_top
- file_download
- show_chart
- image
- translate
- link
- article

location_on

Academia Brasileira de Neurologia - ABNEURO R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices Torre Norte, 04101-000 São Paulo SP Brazil, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revista.arquivos@abneuro.org

rss_feed Acompanhe os números deste periódico no seu leitor de RSS

Acessibilidade / Reportar erro

[TFN1] ^#: from publication; ^##: number of patients treated with pyridostigmine bromide.