Can Azathioprine for myasthenia gravis cause side effects?

Hi doctor,

My brother is a myasthenia gravis patient. He had undergone thymectomy four years back. Since then he is continuously taking Azoran 50, an acetylcholinesterase inhibitor. Surgeons are not able to suggest him for reducing the amount of drugs. Available neurologists also do not have any experience with this rare disease. Please, suggest whether he can stop taking these medicines for rest of his life. If not, can it be reduced to one or two a day? Currently, he is taking three tablets a day. Occasionally, he reduced drugs because of some reason, and did not feel any physiological changes in his body. If he takes this drug for his whole life then will it cause any side effect? Moreover, any suggestion related to lifestyle or food is welcome. Thank you.

Hi doctor,

Thank you very much. I understand that if it becomes asymptomatic, drugs can be stopped till any odd thing comes up. But for the same, we need to reduce gradually the amount of drugs till his body allows. He reduced this dose to two pills a day for some time and did not feel any difference in his physiology. The blood reports that he used to get every three months were also quite normal. Kindly suggest whether he can keep it reducing gradually and then observe the effect. If he succeed to get asymptomatic then stop taking the drug. Please, do clarify. One question is also left that whether this drug is known to have any significant side effect? Secondly, should we go for antibody test (for Anti-Ach) to confirm that he is no more producing anti-acetylcholine Ig. Please clarify this too.