Treatments

Our organization is committed to supporting education by providing education about the therapies available to people diagnosed with MG.  This list provides a snapshot!   Review this list and compare it your current treatment,  Ask your physician if any of the new targeted therapies are right for you.  Make sure you get a pro and con information from your physician. 

Pyridostigmine (Mestinon)

- Mechanism: Pyridostigmine is an acetylcholinesterase inhibitor that increases the availability of acetylcholine at neuromuscular junctions, improving muscle contraction and strength.

- Administration: Oral, occasionally IV.

- Type of Myasthenia Gravis (MG) Antibodies: Effective in patients with acetylcholine receptor (AChR) antibodies.

- Vaccination Required: None.

- Common Side Effects: Gastrointestinal discomfort, muscle cramps, increased salivation, diarrhea.

Prednisone

- Mechanism: Prednisone is a corticosteroid that reduces inflammation and suppresses the immune system, decreasing the production of antibodies that attack the neuromuscular junction in MG.

- Administration: Oral.

- Type: Immunosuppressant.

- Type of Myasthenia Gravis (MG) Antibodies: Effective for both AChR and muscle-specific kinase (MuSK) antibodies.

- Vaccination Required: Annual influenza vaccination and pneumococcal vaccination are recommended due to the immunosuppressive nature of prednisone.

- Common Side Effects: Weight gain, osteoporosis, hypertension, mood changes, increased risk of infections.

Intravenous Immunoglobulin (IVIG)

- Mechanism: IVIG involves the infusion of pooled immunoglobulin G (IgG) from donors, modulating the immune system by neutralizing autoantibodies and influencing antibody production.

- Administration: Intravenous (IV).

- Type: Immunomodulatory.

- Type of Myasthenia Gravis (MG) Antibodies: Effective in acute exacerbations and crises, regardless of specific antibody type.

- Vaccination Required: None specifically required, but standard vaccinations are advisable.

- Common Side Effects: Headache, fever, chills, flu-like symptoms, allergic reactions.

Azathioprine (Imuran)

- Mechanism: Azathioprine is an immunosuppressant that inhibits purine synthesis, reducing the proliferation of immune cells, particularly lymphocytes.

- Administration: Oral.

- Type: Immunosuppressant.

- Type of Myasthenia Gravis (MG) Antibodies: Effective for both AChR and MuSK antibodies.

- Vaccination Required: Annual influenza vaccination and pneumococcal vaccination are recommended due to immunosuppression.

- Common Side Effects: Nausea, vomiting, leukopenia, hepatotoxicity, increased risk of infections.

Cyclosporine (Neoral, Sandimmune, Gengraf)

- Mechanism: Cyclosporine inhibits calcineurin, essential for T-cell activation, thus reducing the immune response.

- Administration: Oral.

- Type: Immunosuppressant.

- Type of Myasthenia Gravis (MG) Antibodies: Effective for both AChR and MuSK antibodies.

- Vaccination Required: Annual influenza vaccination and pneumococcal vaccination are recommended due to immunosuppression.

- Common Side Effects: Nephrotoxicity, hypertension, tremor, hirsutism, increased risk of infections.

Tacrolimus (Prograf)

- Mechanism: Tacrolimus inhibits calcineurin, similar to cyclosporine, suppressing the immune system.

- Administration: Oral.

- Type: Immunosuppressant.

- Type of Myasthenia Gravis (MG) Antibodies: Effective for both AChR and MuSK antibodies.

- Vaccination Required: Annual influenza vaccination and pneumococcal vaccination are recommended due to immunosuppression.

- Common Side Effects: Nephrotoxicity, neurotoxicity, hyperglycemia, hypertension, increased risk of infections.

Plasmapheresis (PLEX)

- Mechanism: Plasmapheresis involves removing plasma containing autoantibodies from the patient's blood and replacing it with donor plasma or a plasma substitute.

- Administration: Via apheresis (blood purification procedure).

- Type: Immunomodulatory.

- Type of Myasthenia Gravis (MG) Antibodies: Effective in acute exacerbations, regardless of specific antibody type.

- Vaccination Required: None.

- Common Side Effects: Hypotension, infection risk at catheter site, electrolyte imbalances.

Mycophenolate Mofetil (Cellcept)

- Mechanism: Mycophenolate mofetil inhibits inosine monophosphate dehydrogenase, reducing lymphocyte proliferation and antibody production.

- Administration: Oral.

- Type: Immunosuppressant.

- Type of Myasthenia Gravis (MG) Antibodies: Effective for both AChR and MuSK antibodies.

- Vaccination Required: Annual influenza vaccination and pneumococcal vaccination are recommended due to immunosuppression.

- Common Side Effects: Gastrointestinal disturbances, leukopenia, hepatotoxicity, increased risk of infections.

Methotrexate (Xatmep, Otrexup, Rasuvo)

- Mechanism: Methotrexate inhibits dihydrofolate reductase, affecting DNA synthesis and cell replication, particularly in rapidly dividing immune cells.

- Administration: Oral, subcutaneous (Subq), or intramuscular (IM).

- Type: Immunosuppressant.

- Type of Myasthenia Gravis (MG) Antibodies: Generally considered for patients who do not respond to other treatments.

- Vaccination Required: Annual influenza vaccination and pneumococcal vaccination are recommended due to immunosuppression.

- Common Side Effects: Nausea, mucositis, hepatotoxicity, leukopenia, increased risk of infections.

Efgartigimod (Vyvgart/Vyvgart Hytrulo)

- Mechanism: Efgartigimod is a neonatal Fc receptor antagonist that reduces the levels of circulating pathogenic IgG antibodies.

- Administration: Intravenous (IV).

- Type: Biological.

- Type of Myasthenia Gravis (MG) Antibodies: Particularly effective for AChR antibodies.

- Vaccination Required: None specifically required, but standard vaccinations are advisable.

- Common Side Effects: Respiratory tract infections, headache, infusion-related reactions.

Eculizumab (Soliris)

- Mechanism: Eculizumab is a monoclonal antibody that inhibits complement protein C5, preventing the formation of the membrane attack complex.

- Administration: Intravenous (IV).

- Type: Biological.

- Type of Myasthenia Gravis (MG) Antibodies: Effective for AChR antibodies.

- Vaccination Required; Meningococcal vaccination is required before starting treatment due to the increased risk of meningococcal infection.

- Common Side Effects: Respiratory tract infections, headache, infusion-related reactions, increased risk of meningococcal infection.

Ravulizumab (Ultomiris)

- Mechanism: Ravulizumab is similar to eculizumab, targeting complement protein C5 to inhibit the complement cascade.

- Administration: Intravenous (IV).

- Type: Biological.

- Type of Myasthenia Gravis (MG) Antibodies: Effective for AChR antibodies.

- Vaccination Required: Meningococcal vaccination is required before starting treatment due to the increased risk of meningococcal infection.

- Common Side Effects: Upper respiratory tract infections, headache, infusion-related reactions, increased risk of meningococcal infections.

Rozanolixizumab-noli (Rystiggo)

- Mechanism: Rozanolixizumab targets the neonatal Fc receptor, reducing levels of pathogenic IgG antibodies.

- Administration: Subcutaneous (Subq).

- Type: Biological.

- Type of Myasthenia Gravis (MG) Antibodies: Effective for AChR antibodies.

- Vaccination Required: None specifically required, but standard vaccinations are advisable.

- Common Side Effects: Headache, injection site reactions, nausea.

Zilucoplan (Zilbrysq)

- Mechanism: Zilucoplan is a complement C5 inhibitor that prevents the formation of the membrane attack complex.

- Administration: Subcutaneous (Subq).

- Type: Biological.

- Type of Myasthenia Gravis (MG) Antibodies: Effective for AChR antibodies.

- Vaccination Required: None specifically required, but standard vaccinations are advisable.

- Common Side Effects: Injection site reactions, headache, upper respiratory tract infections.

Rituximab (Rituxan)

- Mechanism: Rituximab is a monoclonal antibody that targets CD20 on B-cells, leading to their destruction and reduced antibody production.

- Administration: Intravenous (IV).

- Type: Biological.

- Type of Myasthenia Gravis (MG) Antibodies: Effective for MuSK antibodies and refractory AChR antibodies.

- Vaccination Required: None specifically required, but standard vaccinations are advisable.

- Common Side Effects: Infusion reactions, infections, fatigue.

Cyclophosphamide (Cytoxan)

- Mechanism: Cyclophosphamide is an alkylating agent that interferes with DNA replication, reducing immune cell proliferation.

- Administration: Oral or intravenous (IV).

- Type: Immunosuppressant.

- Type of Myasthenia Gravis (MG) Antibodies: Generally reserved for severe or refractory cases, regardless of specific antibody type.

- Vaccination Required: Annual influenza vaccination and pneumococcal vaccination are recommended due to immunosuppression.

- Common Side Effects: Nausea, vomiting, bone marrow suppression, increased risk of infections, bladder toxicity.

Summary:

The treatments for myasthenia gravis (MG) vary widely in mechanism, administration, and specific antibody efficacy. Common approaches include acetylcholinesterase inhibitors like Pyridostigmine for symptomatic relief, immunosuppressants like Prednisone and Azathioprine for long-term management, and biological therapies such as Eculizumab and Rituximab targeting specific immune pathways. The choice of treatment often depends on the type of MG antibodies present (AChR or MuSK) and the severity of the disease. Certain immunosuppressants and biological agents necessitate specific vaccinations, primarily to protect against infections due to immunosuppression or increased susceptibility to particular pathogens.