Treatments for myasthenia gravis have come a long way in helping people live longer, healthier lives. Current treatments — and those in development — can effectively treat the symptoms, allowing partial to complete remission.

Myasthenia gravis (MG) is an autoimmune disorder caused by a breakdown in nerve and muscle communication. This chronic neuromuscular disease weakens voluntary muscles — the ones you control to make movements such as swallowing. The symptoms often start suddenly.

In the past, the outlook for MG was unfavorable. Many people with MG would die as a result of pneumonia or other breathing problems within a few years.

To be clear, there is no cure for MG. But modern treatments can help significantly and allow you to have an average life span and live more comfortably.

The first effective treatment for MG came in 1934 in the form of acetylcholinesterase (AChE) inhibitors. These medications helped improve the mortality rate to 32% within 6 years of diagnosis.

Thymectomies, corticosteroids, azathioprine, plasma exchange, and intravenous immunoglobulin all played a role in improving mortality rates by 5–9%. These treatments also greatly improved quality of life.

But despite these advances, some people with MG face continued challenges due to treatment resistance. They often need frequent hospitalizations due to myasthenic crises and possible immune system resets.

AChE inhibitors

Acetylcholine is an organic compound that acts as a neurotransmitter for functions in your brain and body. It plays a role in both voluntary and involuntary muscle movement.

AChE inhibitors are one of the oldest medication types used for MG that are still in use today. By increasing the amount of acetylcholine available, AChE inhibitors help muscles activate and contract.

These medications provide temporary relief for muscle weakness by stopping AChE from breaking down acetylcholine, thus increasing the amount of acetylcholine available at the neuromuscular junction, the connection between nerves and muscles. Examples of AChE inhibitors include mestinon and pyridostigmine.

As with most treatments, some people will respond to these medications better than others, and some may need other therapies to treat their symptoms.

Immunosuppressive drugs

Several immunosuppressive medications can be helpful to people with MG. These medications target your immune system and help calm it down.

Reduced immune system activity helps decrease inflammation and prevent antibodies from attacking healthy cells in your body because your immune system attacks the neuromuscular junction in MG.

Examples include:

  • tacrolimus
  • azathioprine
  • prednisone
  • mycophenolate mofetil
  • cyclosporine

Though effective, these medications can cause several side effects that healthcare professionals will consider when prescribing them. Your doctor should review potential side effects with you and closely monitor you while you take these medications.

Biologics

Biologics are a more recently available type of medication that is used to treat a variety of conditions, including MG.

Biologics are a more complex type of medication derived from living organisms. They help provide targeted therapy to suppress different portions of your immune system that are responsible for attacking the healthy cells in your body.

Rather than suppressing your immune system more generally, targeted therapies help prevent the components of your immune system from attacking the neuromuscular junction. As a result, targeted therapies may have fewer side effects than other types of medication for MG.

Examples include:

  • rituximab
  • eculizumab
  • efgartigimod

Each type of biologic medication targets different aspects of your immune system, so a healthcare professional may recommend different medications depending on which subtype of MG you develop.

Plasmapheresis and intravenous immunoglobulin

For severe cases of MG, a healthcare professional may recommend plasmapheresis or intravenous immunoglobulin. These therapies help remove defective antibodies that are responsible for attacking the neuromuscular junction.

Plasmapheresis involves filtering blood through a machine that removes the defective antibodies.

Intravenous immunoglobulin involves injecting a high concentration of donor antibodies to provide a temporary reduction in defective antibodies. This is considered an effective therapy option. It may be helpful for 70–90% of people who receive the injections, and its effects may last 28–60 days.

Thymectomy

Another older treatment method still in use today is thymectomy, a procedure to remove the thymus gland. Once this gland has been removed, you should experience symptom relief and possible rebalancing of your immune system.

About 50% of people — with or without a thymoma, a malignant tumor — experience stable, long-lasting, and complete remission after a thymectomy. According to a 2017 research review, undergoing a thymectomy in addition to taking prednisone may be more effective than taking prednisone on its own.

Despite the overall effectiveness of current medications and treatments, 8.5–15% of people with MG continue to have problematic symptoms, even after treatment, or experience negative side effects related to their current therapies.

Healthcare professionals will continue to explore new and better ways to target the underlying mechanisms of the disease. They will likely take into account individual preferences, mechanisms of the disease, indications, risks and benefits, and costs of each therapy.

It is likely that many people will benefit from multiple approaches or combinations of treatments.

Possible future treatments include:

B-cell depletion treatments

B cells are a type of immune cells that produce antibodies.

B-cell depletion plays an important role in the underlying mechanisms of MG. It’s a target-specific therapy meant to intercept autoantibodies and prevent an inflammatory response in the progression of MG. The author of a 2020 review noted that more preclinical studies of MG are needed to validate this new treatment.

Complement inhibitors

Eculizumab is a type of biologic that binds to proteins C5a and C5b and prevents membrane-attacking complexes from forming, thus reducing symptoms. A complement is a type of protein that mediates immune system activity. Future complement inhibitors may provide continued improvements in safety and effectiveness.

Neonatal Fc receptor antagonists

These medications help break down IgG antibodies, thus reducing the autoantibodies involved in MG. The first medication of this type, efgartigimod alfa, received approval in 2021. Another, rozanolixizumab, received approval in 2023.

Two more, batoclimab and nipocalimab, are in the third stage of clinical trials, meaning they may be close to becoming available to treat MG in the general population.

According to a 2024 article in the American Journal of Managed Care, a total of seven new medications are in stage three clinical trials:

  • batoclimab
  • gefurulimab
  • nipocalimab
  • satralizumab
  • cemdisiran
  • pozelimab
  • inebilizumab

These medications will help provide targeted treatment for MG and not simply treat the symptoms. They may also be helpful for people who do not see symptom improvement with current treatment options.

The article also notes that about five new medications are expected to gain approval by 2032. Additionally, eculizumab (Soliris) will lose its patent in 2027, and this will open the door for generic alternatives.

Current therapies for MG include traditional treatments that suppress your immune system and some newer treatments, currently undergoing further study, that target the symptoms. The newer therapies for MG, in their specificity, aim to provide disease modification.

There is currently no cure for MG, but future targeted treatments may help more people enter remission.

Future treatments will help address gaps in effectiveness, reduce side effects, and better treat the underlying disease. Many new therapy options should become available within the next few years, giving doctors more treatment possibilities for MG.