Myasthenia gravis in 2025: five new things and four hopes for the future
Journal: Neurological Update; February 22, 2025
Author(s): S. N. M. Binks, I. M. Morse, Mohammad Ashraghi, A. Vincent, Patrick Waters, M Isabel Leite
Myasthenia gravis (MG) in 2025: Five key developments in the last decade and four hopes for the future
Myasthenia gravis (MG) is an autoimmune condition that affects the nerves and muscles, causing problems such as muscle weakness, drooping eyelids, double vision, difficulty swallowing, speech problems, breathing problems, and fatigue.
This study reviews how the landscape of treatment options for MG has evolved over the last 10 years, between 2015 and 2025, focusing on five promising developments. The paper also discusses four hopes for the next 5-10 years with regard to MG management.
Five promising developments in the last decade:
- Stronger evidence for the effectiveness of thymomectomy
The thymus is a small organ in the chest that plays a role in the immune system. For some people with MG, removing the thymus — a procedure called thymomectomy — can help in the treatment. This is especially true for patients with a particular type of antibody, called the acetylcholine receptor (AChR) antibody. Studies in the last decade have increasingly shown the promise of thymomectomy for MG treatment.
- Expanding treatment options
Until 2016, most treatments were not sufficiently effective and came with severe side effects. However, in the last 10 years, new treatment options for have received approval for MG treatment in various countries, giving patients hope.
Some approved treatments include eculizumab, ravulizumab, zilucoplan, efgartigimod, and rozanolixizumab. Apart from these clinical studies are in progress for various other treatments.
As with all serious and chronic conditions, all treatment options pose certain risks of mild and serious side effects, and patients will need to work carefully with their physician to consider the risks and benefits and the right choice for them.
- Treatment guidelines being updated to reflect new available treatments
In 2020, updated international guidelines were published for MG management, which include newer established treatments such as thymectomy, rituximab, and eculizumab. Additionally, several regional country-specific guidelines have been published as well.
While guidelines provide a helpful framework, treatment decisions should be highly personalized and should depend on the patient’s age, disease severity, antibody type, other illnesses, previous medicines, goals, and risk tolerance.
- Biomarkers to guide personalized treatment
A biomarker is something doctors can measure in the body, such as a blood test result, that gives clues about a disease. For example, blood sugar is a biomarker used in diabetes. In myasthenia gravis, certain antibodies in the blood can help doctors diagnose the condition and choose the most suitable treatment.
Research to identify unique biomarkers for MG is still in early stages but has progressed in some ways, with some biomarkers being closer to clinical use. For example, it has become clear that the underlying antibody type affects how the disease will progress and respond to treatment. Biomarkers will be very helpful for personalized treatment decisions in future.
- A better understanding of how disease age and stage matters
Treatment decisions for MG need to consider both age and stage of the disease. Age refers to the age at which MG is diagnosed, and stage refers to the severity of the disease course.
MG is more commonly being diagnosed in older people, and this means that management needs to consider other common conditions that might be present in these elderly patients (comorbidities), such as high blood pressure, diabetes, high cholesterol, cataracts, or prostate problems.
In terms of disease stage, for many patients, the disease is most severe during the first few years after diagnosis.
Four hopes for the future
- Faster and better testing for diagnosis
Live cell-based assays (blood tests) are described as the most accurate diagnostic method, but they are time-consuming and currently mostly available only in specialist labs. If laboratory testing could become faster, more sensitive, and more widely available, patients could be diagnosed and treated promptly.
- Better protection of the nerve-muscle junction
Quick treatment is essential to protect the connection point between nerves and muscles (nerve-muscle junction) and prevent long-lasting damage and disability. If quick initiation of treatment becomes the norm, it might be possible to improve long-terms outcomes of MG.
- Better understanding of how to treat older people
MG often affects elderly people, but many clinical trials have included mostly younger patients or had upper age limits. Stronger evidence is needed to support treatment decisions in elderly people.
- CAR T-cell therapy as a possible transformative or curative treatment
CAR T-cell therapy is a highly targeted immune treatment that is already used in some blood cancers and is now being explored for autoimmune diseases. While studies in this direction are very exploratory at this moment, CAR-T therapy might emerge as a transformative treatment approach or even a potential cure for MG.
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