Progress in the therapy of myasthenia gravis: getting closer to effective targeted immunotherapies.
Curr Opin Neurol
; 33(5): 545-552, 2020 10.
Article
in English
| MEDLINE | ID: covidwho-1219145
ABSTRACT
PURPOSE OF REVIEW To provide an update on immunomodulating and immunosuppressive therapies in myasthenia gravis and highlight newly approved, or pending approval, therapies with new biologics. RECENT FINDINGS:
Preoperative IVIg is not needed to prevent myasthenic crisis in stable myasthenia gravis patients scheduled for surgery under general anesthesia, based on controlled data. Rituximab, if initiated early in new-onset myasthenia gravis, can lead to faster and more sustained remission even without immunotherapies in 35% of patients at 2 years. Biomarkers determining the timing for follow-up infusions in Rituximab-responding AChR-positive patients are discussed. Most patients with MuSK-positive myasthenia gravis treated with Rituximab have sustained long-term remission with persistent reduction of IgG4 anti-MuSK antibodies. Eculizumb in the extension REGAIN study showed sustained long-term pharmacological remissions and reduced exacerbations. Three new biologic agents showed promising results in phase-II controlled myasthenia gravis trials Zilucoplan, a subcutaneous macrocyclic peptide inhibiting complement C5; Efgartigimod, an IgG1-derived Fc fragment binding to neonatal FcRn receptor; and Rozanolixizumab, a high-affinity anti-FcRn monoclonal antibody. Finally, the safety of ongoing myasthenia gravis immunotherapies during COVID19 pandemic is discussed.SUMMARY:
New biologics against B cells, complement and FcRn receptor, are bringing us closer to successful targeted immunotherapies in the chronic management of myasthenia gravis promising an exciting future for antibody-mediated neurological diseases.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Immunologic Factors
/
Immunotherapy
/
Myasthenia Gravis
Type of study:
Cohort study
/
Experimental Studies
/
Prognostic study
Limits:
Humans
Language:
English
Journal:
Curr Opin Neurol
Journal subject:
Neurology
Year:
2020
Document Type:
Article
Affiliation country:
Wco.0000000000000858
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