Myasthenia gravis care is changing—is your approach keeping up?

In the past decade, the field of myasthenia gravis research has seen numerous advances both in understanding and treatment of the disease. ^[]

“Advances in our understanding of MG pathophysiology—particularly the roles of complement activation and neonatal Fc receptor (FcRn) pathways—have directly led to the development of targeted biologic therapies," says Min Kang, MD, director of the myasthenia gravis clinic at UCSF. "This resulted in early improvements, reducing risk of corticosteroid toxicity and avoiding emergency treatment such as IVIG and plasmapheresis. This represents a shift from delayed to early achievement of disease control and broad immunosuppression, toward more mechanism-based therapies, which is a significant change in practice.”

Here’s everything you need to know to stay current.

New medications

In the past few years, more medications have been developed and approved for the treatment of myasthenia gravis, giving physicians better options for patients. ^[]

“With better understanding of the pathophysiology, meaning that the way the disease develops, there has been better understanding of how the neuromuscular junction is targeted by the immune system, and there have been a few waves of new drugs, a few classes of new drugs targeting those pathways of injury," says Payam Soltanzadeh, MD, an associate clinical professor of neurology who specializes in neuromuscular disorders at UCLA,

Understanding the molecular biology

Key to the advancements in the treatment of the disease has been an improved understanding of the molecular biology of the condition. While it has long been known that myasthenia gravis was an immune-mediated condition, it was not known what specific type of antibodies were responsible.

“We now know very specifically they’re IgG, which simply means a very specific type of pathologic antibody. We now know how those antibodies are made, the molecular biology within the bone marrow, meaning that production of B cells that make these abnormal antibodies,” says Rodrigo Rodriguez, MD, neurologist with Keck Medicine of USC.

Why is that important?

"All of our new medicines are geared to (1) reducing the production of these bad antibodies, (2) clearing these bad antibodies from the system, and (3) preventing the pathologic inflammatory response that these bad antibodies perform or are capable of doing in the person's system," Dr. Rodriguez says.

The new treatments, Dr. Rodriguez explains, are a better alternative than steroid treatments, which were long used for their ability to suppress the immune system. But the drugs often had side effects.

There's more work to be done

Although numerous advances in the field have been made, the experts who spoke with MDLinx say there is still more that needs to be done for people with myasthenia gravis.

“There is still a challenge with seronegative MG in their diagnosis. I would like to see advances in antibody detection and more sensitive electrodiagnostic tests. I’d also like to see improved access to specialized neuromuscular care and diagnostics in community settings," Dr. Kang says.