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Myasthenia Gravis Treatment Updates

  • Neuromuscular Disorders (C Fournier, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

This review presents an update of current treatment strategies for patients with myasthenia gravis (MG) depending on their clinical and immunological characteristics.

Recent findings

Nowadays, the available treatment options for MG are: (1) inhibitors of the acetylcholinesterase, useful as symptomatic treatment; (2) immunosuppressive drugs, the main treatment, initiated and escalated following international guidelines; (3) immunomodulatory drugs (intravenous immunoglobulin and plasma exchange), predominantly used in acute worsening or MG crisis; and (4) thymectomy, performed in patients with thymoma, and also in patients younger than 65 years with anti-acetylcholine receptor antibodies and no thymoma, following the recommendations of a recent international clinical trial. MG is a heterogeneous disease, so the selection of treatments depends on the characteristics of the patient, being especially important, their immunological profile. For instance, anti-MuSK positive patients respond extraordinarily to rituximab. Recently approved drugs, such as eculizumab and subcutaneous immunoglobulin, and ongoing clinical trials are discussed.

Summary

The prognosis of MG patients has improved remarkably due to a better understanding of the heterogeneity of the disease and the appearance of new therapeutic options and approaches. However, side effects are not infrequent and around 10% of patients are refractory to conventional treatments, showing the need to develop new and more specific drugs.

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Funding

This work was funded by the Instituto de Salud Carlos III through the project PI19/01774 (co-funded by the European Union ERDF), PI Isabel Illa and Eduard Gallardo. Elena Cortés-Vicente was supported by a Juan Rodés grant (JR19/00037) from the Fondo de Investigación en Salud, Instituto de Salud Carlos III, Ministry of Health (Spain). Rodrigo Álvarez-Velasco was supported by a grant SLT008/18/00207 from the Health Research and Innovation Strategic Plan (PERIS).

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Authors and Affiliations

  1. Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, C/ Pare Claret 167, 08025, Barcelona, Spain

    Elena Cortés-Vicente MD, PhD, Eduard Gallardo PhD, Rodrigo Álvarez-Velasco MD & Isabel Illa MD, PhD

  2. Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain

    Elena Cortés-Vicente MD, PhD, Eduard Gallardo PhD, Rodrigo Álvarez-Velasco MD & Isabel Illa MD, PhD

  3. Neuromuscular Diseases Laboratory - Biomedical Research Institute Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain

    Elena Cortés-Vicente MD, PhD, Eduard Gallardo PhD, Rodrigo Álvarez-Velasco MD & Isabel Illa MD, PhD

  4. Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain

    Elena Cortés-Vicente MD, PhD, Eduard Gallardo PhD, Rodrigo Álvarez-Velasco MD & Isabel Illa MD, PhD

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  1. Elena Cortés-Vicente MD, PhD
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  2. Eduard Gallardo PhD
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  3. Rodrigo Álvarez-Velasco MD
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  4. Isabel Illa MD, PhD
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Correspondence to Elena Cortés-Vicente MD, PhD.

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Cortés-Vicente, E., Gallardo, E., Álvarez-Velasco, R. et al. Myasthenia Gravis Treatment Updates. Curr Treat Options Neurol 22, 24 (2020). https://doi.org/10.1007/s11940-020-00632-6

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