A comprehensive review of the treatment options in myasthenia gravis

Abstract

The challenge of treating of Myasthenia Gravis (MG) stems from the multiple underlying mechanisms, the varied presentations, the need for chronic immunotherapy, and the long-term consequences of treatment. The disease itself is varied with clinical presentations ranging from droopy eyes to respiratory failure. The underlying etiology may be paraneoplastic or one of several identified antibodies that affect the post-synaptic neuromuscular junction. Treatment strategies vary depending on all of these factors. There are limited medications available for symptomatic treatment of the neuromuscular junction while most treatment focuses on immunotherapy to limit the immune response. Thymectomy is beneficial for most patients with thymoma and many with antibody positive disease. Choosing the right treatments to maximize benefits and limit adverse effects of the medicines is crucial in this chronic disease.

Keywords: Acetylcholinesterase inhibitors; Azathioprine; Complement inhibitor; Corticosteroids; Cyclophosphamide; Cyclosporine; Eculizumab; Edrophonium; Efgartigimod; Fcrn; Immune checkpoint inhibitors; Ivig; Methotrexate; Myasthenia Gravis; Mycophenolate mofetil; Neonatal Fc receptor; Neostigmine; Plasma exchange; Plasmapheresis; Prednisone; Pyridostigmine; Ravulizumab; Rituximab; Rozanolixizumab; Tacrolimus; Thymectomy; Zilucoplan.