Effects of Combination Therapies, Treatment Adverse Effects in Myasthenia Gravis: Nicholas Silvestri, MD, FAAN

WATCH TIME: 3 minutes

"Many patients, at least at the beginning, are on multiple forms of therapy. We try to simplify the regimen as much as we can. There can be [complexities with switching] because basically, you want patients to be stable. You don’t want patients to experience any worsening in the context of a medication change."

Contrary to some other neuromuscular conditions, the treatment landscape for myasthenia gravis (MG) has expanded exponentially over the past 50 years. The toolbox began to grow in the 1960s, with the introduction of corticosteroids and plasma exchange, followed by notable approvals of azathioprine, cyclophosphamide, and intravenous immunoglobulin therapy (IVIg), in the years to follow. More recently, the FDA greenlit options such as mycophenolate mofetil in 2008, rituximab (Rituxan; Genentech) in 2012, eculizumab (Soliris; Alexion) in 2017, efgartigimod (Vyvgart; Agrenx) in 2021, and ravulizumab (Ultomiris; AstraZeneca) in 2022.

When deciding which therapy is best suitable for a patient with MG, it is important to consider the adverse effect profiles, says Nicholas Silvestri, MD. Silvestri, a clinical professor at the University at Buffalo, recently gave a talk at the 2022 American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) annual meeting, on the most common immunosuppressives used for MG, and how each differs based on safety and efficacy. In his talk, he stressed how the improvement of adverse effect profiles of these therapies has changed the way patients are managed.

At AANEM 2022, NeurologyLive^® sat down with Silvestri to discuss his talk, including the impact that adverse events can have on patients with MG. He provided commentary on whether certain treatments are geared for a specific type of patient, as well as the frequency of combination therapy approaches, and the complexities with switching from one therapy to another.