Doctors may recommend oral medications such as pyridostigmine and various intravenous (IV) drugs for the treatment of myasthenia gravis. Thymectomy surgery and plasma exchange may also help.
The aim of myasthenia gravis (mai-uhs-THEE-nee-uh GRAH-viss) treatments is to help reduce muscle weakness and improve a person’s quality of life.
If a person experiences a myasthenic crisis, then emergency treatment may be necessary.
Read on to learn more about the current treatment options for myasthenia gravis. This article also looks at possible challenges with treatments, whether there is a cure for the condition, and more.
Numerous medications can help treat myasthenia gravis.
Pyridostigmine
Doctors may first recommend the anticholinesterase medication pyridostigmine (Mestinon) for myasthenia gravis.
Pyridostigmine is an oral drug that works by
Eculizumab
Eculizumab (Soliris) is a recombinant humanized monoclonal antibody that may help treat generalized myasthenia gravis in adults who have the anti-acetylcholine receptor (AchR) antibody.
The medication blocks some actions of the complement system, which is an immune mechanism that plays a role in myasthenia gravis. A person will receive the treatment intravenously weekly for 4 weeks, and then every 2 weeks afterward.
Ravulizumab
Ravulizumab (Ultomiris) is a long-acting complement inhibitor that works in a similar way to eculizumab.
After a person receives the first infusion, they will require a maintenance dose every 8 weeks.
Efgartigimod
Efgartigimod (Vyvgart) is a type of neonatal Fc receptor inhibitor. It lowers some of the antibodies and pathogenic autoantibodies in the body, reducing symptoms of myasthenia gravis.
A person receives the drug intravenously once per week for 4 weeks. After taking a break after 4 weeks, a doctor may recommend another course of treatment.
Rozanolixizumab-noli
Rozanolixizumab-noli (Rystiggo) is a subcutaneous infusion that can treat myasthenia gravis when a person has either anti-AChR antibodies or anti-muscle-specific kinase (MuSK) antibodies.
A person will receive the treatment once per week for 6 weeks.
Zilucoplan
Zilucoplan (ZILBRYSQ) is a complement inhibitor that a person administers on their own every day.
It helps prevent damage to the neuromuscular junction, which is where nerve cells communicate with the muscles.
Immunosuppressive drugs
Immunosuppressive drugs may help improve muscle strength by controlling the production of abnormal antibodies. Because the drugs can cause significant side effects, it is important to work closely with a medical professional when taking them.
Types of immunosuppressive drugs a doctor may recommend include:
- azathioprine
- mycophenolate mofetil
- prednisone
- tacrolimus
A thymectomy may help reduce symptoms of myasthenia gravis. This procedure removes the thymus gland.
If a person has a thymectomy, they may begin to notice changes in their symptoms within the first few months after the procedure. Symptoms may continue to improve for a few years.
Surgery may also reduce the amount or dosage of medication a person may need to take for myasthenia gravis.
Learn more about myasthenia gravis surgery.
Plasma exchange, or plasmapheresis, and intravenous immunoglobulin (IVIg) are possible treatments during a myasthenic crisis or when symptoms do not improve with maintenance medication.
Plasma exchange involves removing and replacing antibodies in the body’s plasma, which is part of the blood.
IVIg uses a highly concentrated injection of donor antibodies to temporarily change how the immune system works. This can help reduce symptoms of myasthenia gravis by reducing autoantibodies that affect the communication between the nerves and the muscles.
Usually, these treatments only provide improvements for
Certain lifestyle changes may help a person manage myasthenia gravis. For example, the
Avoiding triggers can also help. A person may choose to keep a journal of potential triggers, as certain activities may worsen their symptoms.
Some common triggers include:
- stress
- tiredness or exhaustion
- infection
- certain medications
- surgery
A person can speak with their doctor for advice on ways to manage triggers alongside any medical treatments they recommend. For example, the doctor may suggest a person stays up to date with their flu shots to reduce the likelihood of infection.
Myasthenic crisis is a life threatening complication that affects around
Possible treatments for a myasthenic crisis include:
- receiving assisted ventilation
- undergoing plasma exchange
- taking antibiotics for any bacterial infection
- temporarily stopping anticholinesterase treatment where relevant
- removing any other identifiable triggers
There is no cure for myasthenia gravis. Treatment aims to reduce or manage muscle weakness.
However, not every treatment provides long-term relief. For example, plasma exchange and IVIg only offer relief for
There is also a type of myasthenia gravis that is refractory to treatment. This means that symptoms of myasthenia gravis do not improve with treatments that are generally effective in other cases.
Refractory, or treatment-resistant, myasthenia gravis accounts for about 10% of myasthenia gravis cases.
Research is ongoing to find more treatments for myasthenia gravis. If a person has refractory myasthenia gravis, they may wish to talk with their doctor about any clinical trials that may be available to them.
There is currently no cure for myasthenia gravis. However, treatments can help reduce muscle weakness and improve a person’s quality of life.
How do acetylcholinesterase inhibitors help with myasthenia gravis?
Acetylcholinesterase inhibitors, or anticholinesterase medication, helps electrical signals travel between the nerves and muscles by slowing the breakdown of the neurotransmitter acetylcholine.
Doctors may recommend an acetylcholinesterase inhibitor called pryidostigmine to help improve muscle strength in people with myasthenia gravis.
How do FcRn antagonists help manage myasthenia gravis symptoms?
FcRn antagonists, or neonatal Fc receptor inhibitors, such as efgartigimod, help decrease levels of pathogenic autoantibodies in the body. This in turn can help improve symptoms of myasthenia gravis.
What types of immunosuppressive medications can treat myasthenia gravis?
Types of immunosuppressive medications that can help treat myasthenia gravis include:
- azathioprine
- mycophenolate mofetil
- prednisone
- tacrolimus
The first medication doctors recommend for myasthenia gravis is usually the anticholinesterase drug pryidostigmine.
Other medications that may help include eculizumab, ravulizumab, efgartigimod, rozanolixizumab-noli, zilucoplan, and numerous immunosuppressive drugs.
In some cases, doctors may recommend thymectomy surgery or plasma exchange and intravenous immunoglobulin.
A myasthenic crisis requires emergency treatment. It focuses on supporting breathing and removing any identifiable triggers.
A person can work with their doctor to create a suitable treatment plan based on their individual circumstances. If a person has treatment-resistant myasthenia gravis, they may wish to ask their doctor about clinical trials.