Neurol. praxi. 2025;26(2):129-134 | DOI: 10.36290/neu.2024.077

A new perspective on the generalized myasthenia gravis (gMG) treatment

MUDr. Ivan Martinka, PhD.
Centrum pre neuromuskulárne ochorenia, Neurologická klinika UNB a SZU, Nemocnica Ružinov, Bratislava

Generalized myasthenia gravis (gMG) is a severe disease leading to risk of immediate life threatening and/or quality of life reduction in case of missing treatment. Even with an excellent therapeutic effect of conventional treatment, the treatment itself can lead to patient's quality of life worsening through unpleasant and/or serious adverse effects (AEs). Currently, in the latest recommendations for the gMG treatment, there is a very striking effort to identify patients with highly active gMG in whom early treatment escalation is needed in order to induce rapid gMG symptoms control and quality of life improvement, preferably with as little frequency and intensity of AEs as possible.

Keywords: generalized highly active myasthenia gravis, refractory MG, control of MG symptoms.

Received: October 9, 2024; Revised: November 8, 2024; Accepted: November 18, 2024; Prepublished online: November 19, 2024; Published: May 5, 2025  Show citation

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Martinka I. A new perspective on the generalized myasthenia gravis (gMG) treatment. Neurol. praxi. 2025;26(2):129-134. doi: 10.36290/neu.2024.077.
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References

  1. Bastakoti S, Kunwar S, Poudel S, et al. Rituximab in the Management of Refractory Myasthenia Gravis and Variability of Its Efficacy in Anti-MuSK Positive and Anti-AChR Positive Myasthenia Gravis. Cureus. 2021;13(11):e19416 Go to original source... Go to PubMed...
  2. Bril V, Drużdż A, Grosskreutz J, et al. Safety and efficacy of rozanolixizumab in patients with generalised myasthenia gravis (MycarinG): a randomised, double-blind, placebo-controlled, adaptive phase 3 study. Lancet Neurol. 2023;22(5):383-394. Go to original source... Go to PubMed...
  3. Evoli A, Meacci E. An update on thymectomy in myasthenia gravis. Expert Rev Neurother. 2019;19(9):823-833. Go to original source... Go to PubMed...
  4. Gelinas D, Parvin-Nejad S, Phillips G, Cole C, et al. The humanistic burden of myasthenia gravis: A systematic literature review. J Neurol Sci. 2022;437:120268. Go to original source... Go to PubMed...
  5. Gomez AM, Vrolix K, Martínez-Martínez P. Proteasome inhibition with bortezomib depletes plasma cells and autoantibodies in experimental autoimmune myasthenia gravis. J Immunol. 2011;186(4):2503-13. Go to original source... Go to PubMed...
  6. Gomez AM, Willcox N, Vrolix K. Proteasome inhibition with bortezomib depletes plasma cells and specific autoantibody production in primary thymic cell cultures from early-onset myasthenia gravis patients. J Immunol. 2014;193(3):1055-1063. Go to original source... Go to PubMed...
  7. Howard JF Jr, Bril V, Vu T, Karam C, et al. Safety, efficacy, and tolerability of efgartigimod in patients with generalised myasthenia gravis (ADAPT): a multicentre, randomised, placebo-controlled, phase 3 trial. Lancet Neurol. 2021;20(7):526-536. Go to original source... Go to PubMed...
  8. Hoy SM. Rozanolixizumab: First Approval. Drugs. 2023;83(14):1341-1347. Go to original source... Go to PubMed...
  9. Law C, Flaherty CV, Bandyopadhyay S. A Review of Psychiatric Comorbidity in Myasthenia Gravis. Cureus. 2020;12(7):e9184. Go to original source... Go to PubMed...
  10. Lehnerer S, Jacobi J, Schilling R, Grittner U, et al. Burden of disease in myasthenia gravis: taking the patient's perspective. J Neurol. 2022;269(6):3050-3063. Go to original source... Go to PubMed...
  11. Melzer N, Ruck T, Fuhr P, Gold R, et al. Clinical features, pathogenesis, and treatment of myasthenia gravis: a supplement to the Guidelines of the German Neurological Society. J Neurol. 2016 Aug;263(8):1473-94. Go to original source... Go to PubMed...
  12. Menon D, Bril V. Pharmacotherapy of Generalized Myasthenia Gravis with Special Emphasis on Newer Biologicals. Drugs. 2022;82(8):865-887. Go to original source... Go to PubMed...
  13. Murai H. The Japanese Clinical Guidelines 2022 for Myasthenia Gravis and Lambert-Eaton Myasthenic Syndrome: An Overview. Brain Nerve. 2024;76(1):7-12. Go to original source...
  14. Murai H, Utsugisawa K, Nagane Y, et al. Rationale for the clinical guidelines for myasthenia gravis in Japan. Ann N Y Acad Sci. 2018;1413(1):35-40. Go to original source... Go to PubMed...
  15. Narayanaswami P, Sanders DB, Wolfe G, Benatar M. International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update. Neurology. 2021 ;96(3):114-122. Go to original source... Go to PubMed...
  16. Nawaz SS, Imran MW, Moaz M. Exploring side effects of corticosteroids in myasthenia gravis: Unveiling alternatives for safer treatment. J Pak Med Assoc. 2024;74(6):1211-1212. Go to original source... Go to PubMed...
  17. Nowak RJ, Coffey CS, Goldstein JM, Dimachkie MM, et al. Phase 2 Trial of Rituximab in Acetylcholine Receptor Antibody-Positive Generalized Myasthenia Gravis: The BeatMG Study. Neurology. 2022;98(4):e376-e389. Go to original source... Go to PubMed...
  18. Piehl F, Eriksson-Dufva A, Budzianowska A , et al. Efficacy and Safety of Rituximab for New-Onset Generalized Myasthenia Gravis: The RINOMAX Randomized Clinical Trial. JAMA Neurol. 2022;79(11):1105-1112. Go to original source... Go to PubMed...
  19. Remijn-Nelissen L, Verschuuren JJGM, Tannemaat MR. The effectiveness and side effects of pyridostigmine in the treatment of myasthenia gravis: a cross-sectional study. Neuromuscul Disord. 2022;32(10):790-799. Go to original source... Go to PubMed...
  20. Sanders DB, Wolfe GI, Benatar M, Evoli A, et al. International consensus guidance for management of myasthenia gravis: Executive summary. Neurology. 2016;87(4):419-25. Go to original source... Go to PubMed...
  21. Schneider-Gold C, Reinacher-Schick A, Ellrichmann G, Gold R. Bortezomib in severe MuSK-antibody positive myasthenia gravis: first clinical experience. Ther Adv Neurol Disord. 2017;10(10):339-341. Go to original source... Go to PubMed...
  22. Sussman J, Farrugia ME, Maddison P, Hill M, et al. The Association of British Neurologists' myasthenia gravis guidelines. Ann N Y Acad Sci. 2018 Jan;1412(1):166-169. Go to original source... Go to PubMed...
  23. Špalek P. Myasténia gravis. Cesk Slov Neurol N. 2008;71/104(1):7-24.
  24. Špalek P, Kurča E. Myastenická kríza - základné princípy imunoterapie a intenzivistického manažmentu. Neurológia. 2024;19(1):5-10.
  25. Shuey NH. Ocular myasthenia gravis: a review and practical guide for clinicians. Clin Exp Optom. 2022;105(2):205-213. Go to original source... Go to PubMed...
  26. Tran C, Biswas A, Mendoza M, Katzberg H. Performance of different criteria for refractory myasthenia gravis. Eur J Neurol. 2021;28(4):1375-1384. Go to original source... Go to PubMed...
  27. Wiendl H, Abicht A, Chan A, Della Marina A, et al. Guideline for the management of myasthenic syndromes. Ther Adv Neurol Disord. 2023;16:17562864231213240. Go to original source... Go to PubMed...
  28. Yi JS, Guptill JT, Stathopoulos P, et al. B cells in the pathophysiology of myasthenia gravis. Muscle Nerve. 2018;57(2):172-18. Go to original source... Go to PubMed...




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