Resumo
Objetivo: Compreender o papel dos inibidores da acetilcolinesterase no tratamento da Miastenia Gravis. Métodos: Foi realizada uma revisão integrativa da literatura nas bases de dados PubMed, SciELO e MedLine, considerando artigos publicados entre 2014 e 2024. Foram incluídos estudos em português e inglês que abordavam o uso de inibidores da acetilcolinesterase (IACEs) no manejo da Miastenia Gravis. Após a aplicação dos critérios de inclusão e exclusão, 24 artigos foram selecionados para análise completa. Resultados: Os estudos revisados mostraram que os IACEs atuam aumentando a disponibilidade de acetilcolina na junção neuromuscular, o que melhora significativamente a força muscular e reduz a fadiga dos pacientes. Contudo, não interferem no processo autoimune da doença e podem desencadear efeitos colinérgicos indesejados, como diarreia, cólicas abdominais e broncoconstrição, limitando a dose terapêutica ideal. Também se observou que a resposta clínica varia entre pacientes, exigindo monitoramento contínuo e ajuste individual da dose. Considerações finais: Os IACEs são indispensáveis no manejo sintomático da Miastenia Gravis, mas seus efeitos adversos reforçam a necessidade de acompanhamento individualizado.
Referências
AYRES A, et al. Did the speech of patients with myasthenia gravis decline over 4 years? Codas, 2024; 36(2): e20230055.
BARAKY TC, SIQUEIRA EC. Miastenia gravis. Revista Eletrônica Acervo Saúde, 2023; 23(7): e12726.
BRASIL. Ministério da Saúde. Protocolo Clínico e Diretrizes Terapêuticas da Miastenia Gravis. Brasília: Ministério da Saúde, 2021.
CRISAFULLI S, et al. Myasthenia gravis treatment: from old drugs to innovative therapies with a glimpse into the future. CNS Drugs, 2024; 38(1): 15-32.
DRESSER L, et al. Myasthenia gravis: epidemiology, pathophysiology and clinical manifestations. J Clin Med, 2021; 10(11): 2235.
ESTEPHAN EP, et al. Myasthenia gravis in clinical practice. Arq Neuropsiquiatr, 2022; 80(Supl 1): 257-265.
GALDEANO C, et al. Increasing polarity in tacrine and huprine derivatives: potent anticholinesterase agents for the treatment of myasthenia gravis. Molecules, 2018; 23(3): 634.
GAMBINO CM, et al. Detection of antibodies against the acetylcholine receptor in patients with myasthenia gravis: a comparison of two enzyme immunoassays and a fixed cell-based assay. J Clin Med, 2023; 12(14): 4781.
GILHUS NE, et al. Myasthenia gravis. Nat Rev Dis Primers, 2019; 5(1): 30.
IVOSEVIC A, et al. Mechanism and clinical importance of respiratory failure induced by anticholinesterases. Serb J Exp Clin Res, 2017; 18(4): 349-354.
LASCANO A, et al. Update in immunosuppressive therapy of myasthenia gravis. Autoimmun Rev, 2021; 20(1): 102712.
MARCONI MA, LAKATOS EM. Técnicas de pesquisa. 9.ed. São Paulo: Atlas, 2021.
MEHNDIRATTA MM, et al. Acetylcholinesterase inhibitor treatment for myasthenia gravis. Cochrane Database Syst Rev, 2014; 10: CD006986.
ODIERNA GL, PHILLIPS W. Targeting the safety factor for neuromuscular transmission to treat myasthenia gravis. Res Rep Neuromuscul Dis, 2023; 4(3): 19543.
OJHA PT, et al. The clinical outcome in AChR-positive generalized myasthenia gravis: a retrospective observational study. Ann Indian Acad Neurol, 2023; 26(4): 395-400.
PETROV KA, et al. Specific inhibition of acetylcholinesterase as an approach to decrease muscarinic side effects during myasthenia gravis treatment. Sci Rep, 2018; 8(1): 304.
POHANKA M. Inhibitors of acetylcholinesterase and butyrylcholinesterase meet immunity. Int J Mol Sci, 2014; 15(6): 9809-9825.
RICCIARDI R, et al. Acetylcholinesterase inhibitors are ineffective in MuSK-antibody positive myasthenia gravis: Results of a study on 202 patients. J Neurol Sci, 2024; 461: 123047.
ROTKIEWICZ D, et aI. Nawożenie siarką a valor de uso e tecnológica das sementes de colza de inverno. Rosliny Oleiste, 1996; 17: 257-264.
SCHNEIDER-GOLD C, et al. Understanding the burden of refractory myasthenia gravis. Ther Adv Neurol Disord, 2019; 12: 175628641983224.
SURYADEVARA V, et al. Comparing safety and efficacy of rituximab and eculizumab in treating refractory myasthenia gravis: a systematic review. J Immunol Med Graduates, 2023; 2(2): 138.
TOMSCHIK M, et al. The diagnostic and prognostic utility of repetitive nerve stimulation in patients with myasthenia gravis. Sci Rep, 2023; 13(1): 2985.
VANOLI F, et al. What are the pharmacotherapeutic considerations for the treatment of myasthenia gravis? Expert Opin Pharmacother, 2022; 23(13): 1471-1474.
VEMURI D, et al. Disease severity assessment and short-term outcome in patients with myasthenia gravis. Ann Indian Acad Neurol, 2020; 23(2): 215-219.
YOSHIKAWA H. Autoimmunity to acetylcholine receptor channels. Neurol Clin Neurosci, 2022; 12(3): 143-149.
ZIAADINI B, et al. A retrospective study of the safety and efficacy of rituximab in Iranian patients with myasthenia gravis: a single-center experience. Curr J Neurol, 2022; 21(2): 91-97.
