One of the most basic parts of the immune system are antibodies. Their job is to fight harmful things like germs that come into your body, so you don’t get an infection. In an autoimmune disease, the immune system fights parts of itself. In the case of myasthenia gravis, the body makes antibodies that attack a certain chemical between nerve endings and muscles. This blocks signals from your nerve endings from getting to some of your muscles. Your muscles get tired and weak especially when you use them.
There is no cure for myasthenia gravis. But there are medications that work on the immune system or that help with the symptoms.1 Sometimes more than one medication is given at a time.
One kind of medication is pyridostigmine (Mestinon). This medication increases the amount of the chemical the antibodies most commonly attack. This helps the nerves communicate with the muscles. In some people, muscles work better.
Another group of medications are immunosuppressants. Immunosuppressants weaken (suppress) the immune system. This allows fewer antibodies to attack your body.2 Some examples are corticosteroids like prednisone. Others may include azathioprine (Azasan, Imuran), mycophenolate mofetil (Cellcept), cyclosporine (Sandimmune, Gengraf, others), methotrexate (Trexall, others) and tacrolimus (Astagraf XL, Prograf, others).
Intravenous immunoglobulin (IVIg) therapy may be used when you have a flare-up or crisis. In some cases, it may be used as a maintenance therapy. This medication gives you many healthy antibodies. And you have fewer autoimmune antibodies that attach the chemical. The healthy antibodies live for a few weeks and you may need infusions more often.
Monoclonal antibodies target different areas of your immune system. Rituximab (Rituxan) and eculizumab (Soliris) may be given if the other medications haven’t worked well enough.
A new medication efgartigimod (Vyvgart) has been recently approved by the FDA for adults with anti-AChR antibody positive generalized myasthenia gravis.
All medications have possible side effects. Talk to your care team about your side effects and about any new or worsening symptoms.
FDA (U.S. Food and Drug Administration). AChR (Acetylcholine receptor).
1. Narayanaswami P, Sanders DB, Wolfe G, Benatar M, Cea G, Evoli A, Gilhus NE. International consensus guideline for management of myasthenia gravis. 2020 Update. Neurology. 2021;96(3):14-122. DOI: 10.1212/WNL.0000000000011124.
2. Sanders DB, Wolfe GI, Benatar M, Evoli A, Gilhus NE, Illa I, Kuntz N, et.al. International consensus guidance for management of myasthenia gravis: executive summary. Neurology. 2016;87(4). DOI: 10.1212/WNL.0000000000002790.
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