Targeting Different Mechanisms of Action to Treat Myasthenia Gravis

EP: 1.Myasthenia Gravis and Underlying Pathophysiology

EP: 2.Subgroups and Phenotypes of Myasthenia Gravis

EP: 3.Atypical Presentation of Myasthenia Gravis and Importance of Early Diagnosis

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EP: 4.Targeting Different Mechanisms of Action to Treat Myasthenia Gravis

EP: 5.Efgartigimod In Myasthenia Gravis

EP: 6.Complement Inhibitors in Myasthenia Gravis

This is a video synopsis of a discussion involving Neelam Goyal, MD, who provides valuable insights into the treatment strategies for myasthenia gravis (MG). Dr. Goyal begins by highlighting the role of the thymus in MG development, with approximately 10% of MG patients having thymoma, requiring surgical intervention, and 60-70% exhibiting thymic hyperplasia. Describing MG as an AChR (acetylcholine receptor)-dependent, FcRN (neonatal Fc receptor)-mediated disease, she explores both upstream and downstream therapeutic approaches.

Upstream therapies targeting T cells and B cells include traditional options like prednisone and steroid-sparing agents, while recent years have seen a surge in therapeutics for MG. Dr. Goyal discusses B cell depletion using rituximab, an anti-CD20 drug, especially effective in musk antibody disease. FcRN inhibitors, which compete with IgG and reduce pathogenic antibody levels, and complement inhibitors blocking the terminal pathway, preventing antibody-mediated complement activation, are also promising treatment avenues.

Dr. Goyal elaborates on the Rhino-Max study, demonstrating the efficacy of low-dose rituximab in early-onset AChR-positive MG. She emphasizes the importance of considering seropositivity and disease severity when choosing treatments, with seropositive patients having access to newer therapies. FcRN inhibitors and complement inhibitors offer downstream effects, reducing pathogenic antibody levels and preventing complement activation.

Expressing enthusiasm for emerging therapies, Dr. Goyal anticipates advancements in both upstream and downstream treatments. She mentions CAR T therapy in the pipeline, offering a promising option impacting T cells and B cells. Dr. Goyal underscores the significance of these advancements, especially for patients with refractory and resistant MG, and emphasizes the critical role of early diagnosis to initiate timely and effective treatment.

Video synopsis is AI-generated and reviewed by NeurologyLive® editorial staff.