Novel Immunotherapies for Myasthenia Gravis

Abstract

Sruthi S Nair,1,2 Saiju Jacob1,3 1Department of Neurology, University Hospitals Birmingham, Birmingham, B15 2TH, UK; 2Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India; 3Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UKCorrespondence: Saiju Jacob, Consultant Neurologist, University Hospitals Birmingham, Edgbaston, Birmingham, B15 2TH, United Kingdom, Tel [phone], Fax [phone], Email [email protected]: Myasthenia gravis (MG), a prototype autoimmune neurological disease, had its therapy centred on corticosteroids, non-steroidal broad-spectrum immunotherapy and cholinesterase inhibitors for several decades. Treatment-refractory MG and long-term toxicities of the medications have been major concerns with the conventional therapies. Advances in the immunology and pathogenesis of MG have ushered in an era of newer therapies which are more specific and efficacious. Complement inhibitors and neonatal Fc receptor blockers target disease-specific pathogenic mechanisms linked to myasthenia and have proven their efficacy in pivotal clinical studies. B cell-depleting agents, specifically rituximab, have also emerged as useful for the treatment of severe MG. Many more biologicals are in the pipeline and in diverse stages of development. This review discusses the evidence for the novel therapies and the specific issues related to their clinical use.Keywords: myasthenia gravis, refractory myasthenia gravis, complement inhibitors, FcRn blocker, B cell depletion

Keywords

• myasthenia gravis
• refractory myasthenia gravis
• complement inhibitors
• fcrn blocker
• b cell depletion