Expert Clinical Perspectives: How should newer therapeutic agents be incorporated into the treatment of patients with myasthenia gravis?-Article

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Generalized myasthenia gravis (gMG) is a neuromuscular disorder that causes muscle weakness. The traditional treatment approach for gMG includes the use of acetylcholinesterase inhibitors, corticosteroids, and immunosuppressant therapies. However, in recent years, new therapeutic agents with novel mechanisms of action have been approved for the treatment of gMG. These include complement inhibitors (eculizumab and ravulizumab) and neonatal Fc receptor (FcRn) inhibitors (efgartigimod and rozanolixizumab). <br /><br />The timing and integration of these newer therapies into the treatment paradigm for gMG are currently unclear. One approach to selecting a newer therapeutic agent is to consider the value of the treatment in terms of clinical improvement, cost, side effects, and treatment burden. These novel therapies can be used in two specific clinical situations: as "bridge therapy" in clinically unstable patients and as additional options for treatment-refractory patients. However, there are downsides to these therapies, including cost, unique side effect profiles, and the need for intravenous or subcutaneous administration.<br /><br />A survey of neurologists specializing in neuromuscular disorders found that azathioprine and mycophenolate mofetil were the most commonly used first-line immunosuppressant therapies, while intravenous immunoglobulin (IVIg) was considered optimal "bridge therapy." The survey also highlighted the importance of considering patient preferences and the potential side effects and costs of newer therapies when making treatment decisions.<br /><br />Overall, the incorporation of newer therapeutic agents into the treatment of gMG is an evolving process. Further research is needed to determine the optimal placement of these therapies in the treatment algorithm and to better understand their safety and efficacy in different patient populations.

Keywords

generalized myasthenia gravis

neuromuscular disorder

muscle weakness

acetylcholinesterase inhibitors

corticosteroids

immunosuppressant therapies

complement inhibitors

neonatal Fc receptor inhibitors

bridge therapy

treatment-refractory patients