Several more myasthenia gravis therapy options now available

Most patients with chronic, neuromuscular, autoimmune myasthenia gravis (MG) are positive for acetylcholine receptor antibodies. Traditional therapy involves anticholinesterase inhibitors and immunosuppressants, including corticosteroids, that come with significant long-term tolerability concerns. Recent regulatory approvals of the complement inhibitors eculizumab, ravulizumab and zilucoplan, and neonatal Fc receptor blockers efgartigimod and rozanolixizumab, provide new, non-oral, monotherapy or add-on treatment options for refractory and/or severe MG. In randomized trials, these agents improved activities of daily living scores and were generally well tolerated, although headache was common and some serious infections occurred. Cost, non-oral routes of administration and the need for immunisations (for complement inhibitors) are the main limitations of treatment.