The new MG pipeline: Are we finally getting it right?
Industry Buzz
MG is a treatable disease, and patients do best when they are diagnosed early, managed in a multidisciplinary setting, and have access to personalized care. As the field advances, collaboration across specialties and proactive patient-centered approaches will be key to improving outcomes.
Min Kang, MD, director of the myasthenia gravis clinic at UCSF
The past decade has been transformative for treatment options for myasthenia gravis (MG). [] Experts say the advances made have revolutionized treatment, with hopes that more is still to come in future years.
MDLinx spoke with three experts in myasthenia gravis about new approaches in the condition, and their hopes for the future.
Min Kang, MD, director of the myasthenia gravis clinic at UCSF, tells MDLinx she's excited for advances in understanding the immunopathology in MG, which will lead to "more targeted and sustained therapy, particularly for patients with refractory MG. CAR-T and bi-specific T-cell engagers could be potentially the future of MG treatment."
"This transformative disease modification may lead to decreased treatment burden or even remission without chronic immunosuppression,” she says.
FcRn inhibitors and complement inhibitors have made a significant impact by providing rapid symptom relief with fewer systemic side effects than traditional immunosuppressants, Kang continues.
"These therapies are game changers, particularly for patients who have not responded well to standard treatments," she says.
Related: Myasthenia gravis care is changing—is your approach keeping up?Improvements in understanding of molecular biology
In the past decade, there has been an improved understanding of the molecular biology behind the disease, paving the way for numerous treatment options. []
Rodrigo Rodriguez, MD, a neurologist with Keck Medicine of USC, is hopeful more clues will be unlocked in the future through a better understanding of the pathologic antibodies underpinning myasthenia gravis.
In particular, he looks forward to “continued understanding of the production of the pathologic antibody," leading to what he says is called “directed B-cell therapy—reducing the production of pathologic B cells that are making the antibodies in the first place. So we have to have a better understanding of how that part of the immune system operates. And we have to have a better understanding of why those pathologic B cells are produced in the first place,” he says.
He continues: “If we find out how we can reduce the production of those pathologic B cells, we then would need to decrease production of the pathologic auto-antibody without making the patient at risk for opportunistic infections or compromising the patient's immune system.”
CAR T-cell therapy
CAR T-cell therapy is a form of immunotherapy traditionally used in cancer treatment in which a patient’s own immune cells are used to fight cancer.
Researchers are exploring this idea in clinical trials of CAR T-cell therapy for patients with myasthenia gravis. Experts say this represents an exciting advancement in the field, offering targeted therapy options. []
“More targeted therapies and identifying better biomarkers are the ones that are going to be interesting in the future, meaning that when a patient comes to your clinic, you would be able to kind of have a better prediction of their response and also be able to say, ‘Okay, which drug is going to work better for this patient?’ and 'How aggressive I should be with this patient?' So if we get to that point, that would be nicer,” says Payam Soltanzadeh, MD, an associate clinical professor of neurology who specializes in neuromuscular disorders at UCLA.
Collaboration between fields
As further research and clinical trials into more treatments for myasthenia gravis continue, Dr. Kang says that, along with the advances in research, there also needs to be collaboration between specialties for the benefit of patients.
“MG is a treatable disease, and patients do best when they are diagnosed early, managed in a multidisciplinary setting, and have access to personalized care. As the field advances, collaboration across specialties and proactive patient-centered approaches will be key to improving outcomes,” she says.