It has been used in the past, mostly in Europe.

It has a somewhat different mode of action and pharmacology than mestinon.

According to my neurologist it may possibly be more effective in some patients with MuSK.

I do not see any reason for someone who is doing well on mestinon to change to it, but it could be an option for someone who is not responding well to mestinon. Like mestinon, it is only symptomatic treatment and not disease-modifying. With the advantages (once you stop it, you lose its effect very rapidly) and dissadvantages of every other symptomatic treatment.

I am surprised that those are the only options of treatment for patients under medicare. Aren't patients under medicare given the chance for remission?