Myasthenia Gravis Treatment Updates

Purpose of review: This review presents an update of current treatment strategies for patients with myasthenia gravis (MG) depending on their clinical and immunological characteristics. Recent findings: Nowadays, the available treatment options for MG are: (1) inhibitors of the acetylcholinesterase, useful as symptomatic treatment; (2) immunosuppressive drugs, the main treatment, initiated and escalated following international guidelines; (3) immunomodulatory drugs (intravenous immunoglobulin and plasma exchange), predominantly used in acute worsening or MG crisis; and (4) thymectomy, performed in patients with thymoma, and also in patients younger than 65 years with anti-acetylcholine receptor antibodies and no thymoma, following the recommendations of a recent international clinical trial. MG is a heterogeneous disease, so the selection of treatments depends on the characteristics of the patient, being especially important, their immunological profile. For instance, anti-MuSK positive patients respond extraordinarily to rituximab. Recently approved drugs, such as eculizumab and subcutaneous immunoglobulin, and ongoing clinical trials are discussed. Summary: The prognosis of MG patients has improved remarkably due to a better understanding of the heterogeneity of the disease and the appearance of new therapeutic options and approaches. However, side effects are not infrequent and around 10% of patients are refractory to conventional treatments, showing the need to develop new and more specific drugs.