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Review
. 2022 Mar 14;11(6):1597.
doi: 10.3390/jcm11061597.

Current Treatment of Myasthenia Gravis

Mohammed K Alhaidar  1 , Sumayyah Abumurad  1 , Betty Soliven  1 , Kourosh Rezania  1
Affiliations
Review

Current Treatment of Myasthenia Gravis

Mohammed K Alhaidar et al. J Clin Med. .

Abstract

Myasthenia gravis (MG) is the most extensively studied antibody-mediated disease in humans. Substantial progress has been made in the treatment of MG in the last century, resulting in a change of its natural course from a disease with poor prognosis with a high mortality rate in the early 20th century to a treatable condition with a large proportion of patients attaining very good disease control. This review summarizes the current treatment options for MG, including non-immunosuppressive and immunosuppressive treatments, as well as thymectomy and targeted immunomodulatory drugs.

Keywords: azathioprine; beta adrenergic; corticosteroids; cyclophosphamide; cyclosporine; eculizumab; efgartigimod; intravenous immunoglobulin; methotrexate; myasthenia gravis; plasma exchange; prednisone; pyridostigmine; stem cell transplant; tacrolimus; terbutaline.

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Conflict of interest statement

Rezania K. has received honoraria for consultations, guest speaker, and serving on advisory boards for Alexion, Argenx, Kabafusion and Grifols. Soliven B. and Rezania K. have received funding from Alexion for conducting clinical trials on MG and ALS. Alhaidar M.K. and Abumurad S. declare no conflict of interest.

Figures

Figure 1
Figure 1
Azathioprine metabolism. Deficiency of thiopurine methyltransferase results in increased 6-thioguanine levels, which may result in myelosuppression. On the other hand, increased activity of thiopurine methyltransferase will lead to increased levels of 6-methylmercaptopurine, which predisposes to hepatotoxicity (hypermethylation). Allopurinol can result in severe leukopenia if administered with the usual dose of azathioprine as it inhibits xanthine oxidase.
Figure 2
Figure 2
Overall treatment strategy of myasthenia gravis. MuSK: muscle specific tyrosine kinase; Ab: antibody; AChR: acetylcholine receptor; IVIG: intravenous immunoglobulin; PLEX: Plasma exchange.
See this image and copyright information in PMC

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