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For me, being anti acetylcholine, my Nero has done all to keep me off any steroids. Mestinon at first eventually up to 120 mg 6 times a day, then added CellCept. Did semi ok, finally after3 years approved for Ultomiris, which has been good for me. Eating and talking ok, some throat stress as the time between infusions wears on, frill difficulty balance and overall weakness, but I can cope and continue a semi decent life as long as I plan things