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Liu et al. Developing treatment guidance for myasthenia gravis

Statement 1 mentioned that PLEX and IVIg are used especially to those who have limited experiences
as short-term treatment in MG patients with life- or practice in countries or regions that have limited
threatening signs. Our clinical experiences suggest resources to develop local treatment guidelines. More
that PLEX and IVIg alone are not sufficient in manifest importantly, it is an extraordinary example of how the
MG crisis cases. [17,18] There are many complications RAND/UCLA appropriate methods can help to develop
during MG crisis (such as pneumonia, pneumothorax, a consensus guidance for treatment of rare diseases,
heart failure and renal failure etc.) when PLEX and bringing together the best of existing scientific results
IVIg are not appropriate. Instead, a comprehensive with the experience of specialists around the world.
treatment plan should be designed for each individual
MG patient undergoing crisis. Authors’ contributions
Conceived the manuscript: W.B. Liu, W. Fang
Statement 2 mentioned that the choice between Wrote the first draft in Chinese: W.B. Liu
PLEX and IVIg depends on conditions of individual Translated the first draft into English: H. Ran
patient such as sepsis and renal failure. In addition, Developed the conceptual structure and revised the
our clinical experiences suggest that IVIg is safer than manuscript: W. Fang
PLEX to patients with cardiovascular disorders. [17] Participated in the clinical work and approved the final
draft: C.Y. Ou, L. Qiu, Z.D. Huang, Z.Q. Lin, Y.K. Li,
Thymectomy X.X. Liu, H. Huang
We totally agree with the statements about pre-
pubertal patients with generalized AchR antibody- Financial support and sponsorship
positive MG and all patients with MG with thymoma. This paper is supported by grants from the China
Our research has shown that thymectomy on National Natural Sciences Foundation (30870850,
juvenal generalized MG patients did not affect their 81071002, 81371386, 81620108010) and the Clinical
growth. [19,20] study of 5010 plan of Sun Yat-sen University (2010003).

Statement 5 mentioned that less invasive thymectomy Conflicts of interest
approaches such as endoscopic and robotic There are no conflicts of interest.
approaches appear to yield similar results to more
aggressive approaches and show a good track record Patient consent
for safety in experienced center. However, based on There is no patient data involved.
our experiences, endoscopic and robotic approaches
to thymectomy are much less desirable for thymoma Ethics approval
than extended thymectomy. [21-23] There is no ethics issue in this paper.

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