Advances in the Treatment of Myasthenia Gravis

Nils Erik Gilhus


Future Neurology. 2012;7(6):701-708. 

In This Article

Future Perspective

Although today's MG treatment is effective in most patients, leaving them with relatively mild symptoms and moderate side effects, the treatment is by no means specific or curative. It remains a paradox that the pathogenesis of the disease is known in detail, pin-pointing specific autoantibodies as the cause of the symptoms, but that the immune system is still treated without using this specific knowledge. The aim should be to suppress the anti-AChR, anti-MuSK or anti-LRP4 immune response in MG patients without influencing the rest of the immune system. That means treating MG patients at the specific autoantibody, B-cell or T-cell level.

Until an antigen-specific MG treatment is available, it remains a challenge to evaluate new and promising immunoactive drugs for MG. Many such drugs are licensed for a hematologic disease, multiple sclerosis or in oncology, and many more are in the pipeline. Several of them would most probably be effective in MG as well. However, it is difficult to get experience regarding such a rare disease, and for a disease where the great majority of patients are well controlled with the present standard therapy. Prospective and controlled studies will probably not be undertaken for most of these potential treatments.

The ultimate aim is to identify the cause of MG, and then to prevent or treat this cause. Genetic predisposition is relevant, but external causative factors are probably more important. Intrathymic Epstein-Barr virus infection has been suggested, but any presence of virus in the MG thymus has not been confirmed.[16–18]