Myasthenia Gravis Treatment Options

Although there is currently no cure for myasthenia gravis, a variety of treatments—including oral medications, injectable therapies, intravenous treatments, and surgery—can help improve symptoms and quality of life.  The choice of myasthenia gravis treatment can vary according to your age, disease severity, and response to treatment.

The primary goals of treatment are to improve muscle strength, reduce symptoms, prevent disease exacerbations, and minimize treatment-related side effects.

Oral Therapy:

• Cholinesterase inhibitors (anticholinesterases):
  • These drugs inhibit the enzyme that breaks down acetylcholine, a chemical messenger that helps nerves communicate with muscles. By increasing the availability of acetylcholine, these medications can improve muscle strength and reduce muscle weakness.
  • Medications: pyridostigmine (Mestinon) and neostigmine (Prostigmin).
• Corticosteroids:
  • Corticosteroids suppress the immune system and help reduce the production of harmful antibodies that contribute to myasthenia gravis symptoms.
  • It may take 2 to 4 weeks for these drugs to show their effects. Long-term corticosteroid use can cause brittle bones, high blood sugar levels, and weight gain. 
  • Medications: prednisone (Deltasone). 
• Immunosuppressive drugs: 
  • Similar to corticosteroids, these medications help control an overactive immune system and reduce the production of antibodies that interfere with nerve-to-muscle communication.
  • Medications: azathioprine (Imuran), mycophenolate mofetil (CellCept), cyclosporine (Sandimmune), and tacrolimus (Prograf). In some cases, other immunosuppressive medications may also be considered.

• FcRn Inhibitors:
  • FcRn inhibitors are a newer class of targeted therapies that help reduce levels of harmful antibodies involved in myasthenia gravis. These treatments may be considered for patients with generalized myasthenia gravis whose symptoms remain uncontrolled despite conventional therapies.
  • Medications: efgartigimod (Vyvgart) and rozanolixizumab (Rystiggo). 

Other Medications and Surgeries

The following medications and surgeries may be used alone or in combination with corticosteroids. 

Intravenous (IV) Therapy

Intravenous therapy is often used as a short-term treatment for severe symptoms, myasthenic crisis, or a sudden worsening of disease activity.

• Plasmapheresis (plasma exchange): 
  • This procedure removes harmful antibodies from the bloodstream, helping improve communication between nerves and muscles.
  • Risks may include a drop in blood pressure, bleeding, and abnormal heart rhythm. 
• Intravenous immunoglobulin (IVIG):
  • IVIG is made from antibodies collected from healthy donors and helps regulate the immune system. It is typically administered intravenously over several hours each day for 2 to 5 consecutive days.
  • Side effects may include infusion site reactions, chills, dizziness, headaches, and fluid retention.
• Targeted Biologic Therapies:
  • These treatments use biologically engineered proteins to target specific parts of the immune system involved in myasthenia gravis. Depending on the medication, treatment may be administered intravenously or by subcutaneous injection.
  • Medications may include rituximab (Rituxan), eculizumab (Soliris), ravulizumab (Ultomiris), and zilucoplan (Zilbrysq). 
  • These therapies are generally reserved for patients with generalized myasthenia gravis who have persistent symptoms despite conventional treatment. 
  • Some targeted therapies may increase the risk of serious infections. Your healthcare provider may recommend certain vaccinations before treatment begins.

Surgery

The thymus gland is an organ located in the chest. The thymus gland is part of the immune system and plays an important role in the development and maturation of T lymphocytes (T cells), a type of white blood cell involved in immune function. The thymus is believed to play an important role in the abnormal immune response that causes myasthenia gravis. Many patients with MG have thymic abnormalities, including thymic hyperplasia or thymoma (a tumor of the thymus gland).

Thymectomy may be recommended for patients with a thymoma and may also benefit certain patients with generalized myasthenia gravis even when a tumor is not present.  In patients who require surgery, this involves the removal of the thymus gland (thymectomy). This procedure may help improve symptoms, reduce medication requirements, and improve long-term disease control. However, it may take months to years before the full benefits become apparent.

Minimally invasive approaches, such as video-assisted thoracoscopic surgery (VATS) and robotic-assisted thymectomy, are associated with smaller incisions, less postoperative pain, and shorter hospital stays compared with traditional open surgery.