Five therapies are currently approved by the FDA for treating the symptoms of myasthenia gravis, allowing partial to complete remission. Research suggests that five new therapies may become available by 2032.
Myasthenia gravis is an autoimmune disorder caused by a breakdown in nerve and muscle communication. The condition weakens voluntary muscles, which are those you control to make movements like swallowing.
The first effective treatment for myasthenia gravis was acetylcholinesterase (AChE) inhibitors, which were introduced in
Other drugs like thymectomies, corticosteroids, azathioprine, plasma exchange, and intravenous immunoglobulin also helped improve quality of life and mortality rates by 5% to 9%.
Despite these advances, however, some people with myasthenia gravis face continued challenges due to treatment resistance. They often need frequent hospitalizations due to myasthenic crises and possible immune system resets.
There’s still no cure for myasthenia gravis, but modern treatments can help significantly and allow you to have an average life span and live more comfortably.
Keep reading to learn more about the latest treatments for myasthenia gravis.
As of December 2024, five therapies for myasthenia gravis have been approved by the Food and Drug Administration (FDA).
The latest two medications, rozanolixizumab-noli (Rystiggo) and zilucoplan (Zilbrysq), were FDA-approved in 2023.
Rozanolixizumab-noli (Rystiggo)
This is the first medication approved by the FDA to help treat both anti-acetylcholine receptor myasthenia gravis and anti-muscle-specific kinase antibody-positive myasthenia gravis.
Rozanolixizumab-noli is a monoclonal antibody that works by blocking a receptor called neonatal Fc receptor (FcRn). This receptor usually helps recycle autoantibodies, which can worsen myasthenia gravis symptoms. This drug blocks autoantibodies from being recycled, causing them to be broken down instead.
Zilucoplan (Zilbrysq)
This medication is the first to be approved by the FDA for self-administration, done via injection.
Zilucoplan is a complement inhibitor that blocks the C5 protein. This decreases the immune system response, which helps decrease symptoms in myasthenia gravis.
There are five therapies approved by the FDA for the treatment of myasthenia gravis as of December 2024.
Along with rozanolixizumab-noli and zilucoplan, there are three other medications:
Eculizumab (Soliris)
The is the first therapy to be FDA-approved for myasthenia gravis, back in 2017.
Eculizumab (Soliris) works as a complement inhibitor. A complement is a type of protein that mediates immune system activity.
Eculizumab is a type of biologic that binds to proteins C5a and C5b and prevents membrane-attacking complexes from forming.
Biologics are a class of drugs derived from living organisms. They target specific parts of your immune system that are responsible for attacking the healthy cells in your body.
Targeted therapies help prevent the components of your immune system from attacking the neuromuscular junction. As a result, targeted therapies may have fewer side effects than other types of medication for myasthenia gravis.
Eculizumab is administered intravenously.
Efgartigimod (Vyvgart)
This medication was FDA-approved in 2021 for the treatment of myasthenia gravis.
It’s an FcRn antagonist. These medications help break down immunoglobulin G (IgG) antibodies, thus reducing the autoantibodies involved in myasthenia gravis.
Ravulizumab (Ultomiris)
FDA-approved in 2022, this a long-acting C5 complement inhibitor that works in a similar fashion as eculizumab.
However, ravulizumab lasts longer in your system, so you require less frequent intravenous infusions. This means you can receive treatment every 8 weeks instead of every 2 weeks.
Despite the overall effectiveness of current treatments, 8.5% to 15% of people with myasthenia gravis continue to have problematic symptoms, even after treatment, or experience negative side effects related to their current therapies.
Researchers are developing and testing new treatments for myasthenia gravis, which include biologics, complement therapies, and FcRn antagonists.
According to a 2024 article, the following seven medications are in stage three clinical trials, which means they may be close to becoming available to treat myasthenia gravis in the general population:
- batoclimab
- gefurulimab
- nipocalimab
- satralizumab
- cemdisiran
- pozelimab
- inebilizumab
These medications will help provide targeted treatment for myasthenia gravis rather than simply treating the symptoms. They may also be helpful for people who do not see symptom improvement with current treatment options.
The article also notes that about five new medications are expected to gain approval by 2032. Additionally, eculizumab (Soliris) will lose its patent in 2027, and this will open the door for generic alternatives.
Researchers are also looking into the possible benefits of B-cell depletion treatments, which may play important roles in the underlying mechanisms of myasthenia gravis.
B cells are a type of immune cells that produce antibodies. B-cell depletion is a target-specific therapy meant to intercept autoantibodies and prevent an inflammatory response in the progression of myasthenia gravis.
However, more preclinical studies of myasthenia gravis are needed to validate this new treatment.
Healthcare professionals may also recommend a variety of traditional treatments to help improve myasthenia gravis symptoms.
However, it’s important to speak with a doctor about the possible side effects of these medications.
AChE inhibitors
Acetylcholine is an organic compound that acts as a neurotransmitter for functions in your brain and body. It plays a role in both voluntary and involuntary muscle movement.
AChE inhibitors are one of the oldest medication types used for myasthenia gravis that are
AChE inhibitors help muscles activate and contract by increasing the amount of acetylcholine available.
This could help provide temporary relief for muscle weakness by stopping AChE from breaking down acetylcholine, thus increasing the amount of acetylcholine available at the neuromuscular junction, the connection between nerves and muscles.
Pyridostigmine (Mestinon) is an
Immunosuppressive drugs
Immunosuppressive medications target your immune system and help calm it down.
Reduced immune system activity
Examples include:
- tacrolimus
- azathioprine
- prednisone
- mycophenolate mofetil
- cyclosporine
Plasmapheresis and intravenous immunoglobulin
For severe cases of myasthenia gravis, a healthcare professional may recommend plasmapheresis or intravenous immunoglobulin. These therapies
Plasmapheresis involves filtering blood through a machine that removes the defective antibodies.
Intravenous immunoglobulin involves injecting a high concentration of donor antibodies to temporarily reduce defective antibodies. It’s helpful for
Thymectomy
Thymectomy is a procedure to remove the thymus gland. Once this gland has been removed, you should experience symptom relief and possible rebalancing of your immune system.
About
Current therapies for myasthenia gravis include treatments that suppress the immune system and others that target the symptoms.
The newer therapies for myasthenia gravis, in their specificity, aim to provide disease modification.
There is currently no cure for myasthenia gravis, but future targeted treatments may help more people enter remission. Many new therapy options may become available within the next few years, giving doctors more treatment possibilities for myasthenia gravis.