First-line pharmacologic therapy for MG includes which class of drugs?

• A. Acetylcholinesterase inhibitors (pyridostigmine or neostigmine)
• B. Beta blockers
• C. Immunosuppressants only
• D. Antidepressants

Answer: (A)

In myasthenia gravis, the first-line pharmacologic approach is to improve transmission at the neuromuscular junction by increasing acetylcholine availability. The autoimmune process reduces the number of functional acetylcholine receptors, so boosting acetylcholine in the synaptic cleft helps the remaining receptors respond more effectively. Acetylcholinesterase inhibitors do exactly this: they block the breakdown of acetylcholine, prolonging its action and enhancing the end-plate response. This leads to quicker and more consistent muscle contractions, particularly improving eye movements, speech, swallowing, and proximal limb strength. They provide rapid, symptomatic relief while longer-term strategies address the autoimmune component. While other therapies like immunosuppressants or corticosteroids may be needed for disease control, they are not used as the initial symptomatic treatment.