New biologics are rapidly opening up target-specific therapeutic opportunities for myasthenia gravis (MG) — an autoimmune disease caused by antibodies against neuromuscular junction proteins. Two recent trials have now demonstrated the efficacy and tolerability of the complement C5 inhibitor zilucoplan and the FcRn inhibitor rozanolixizumab in patients with generalized MG.
This is a preview of subscription content, access via your institution
Access options
Access Nature and 54 other Nature Portfolio journals
Get Nature+, our best-value online-access subscription
$29.99 / 30 days
cancel any time
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
References
Dalakas, M. C. Immunotherapy in myasthenia gravis in the era of biologics. Nat. Rev. Neurol. 15, 113–124 (2019).
Dalakas, M. C. Progress in the therapy of myasthenia gravis: getting closer to effective targeted immunotherapies. Curr. Opin. Neurol. 33, 545–552 (2020).
Dalakas, M. C. Role of complement, anti-complement therapeutics, and other targeted immunotherapies in myasthenia gravis. Expert Rev. Clin. Immunol. 18, 691–701 (2022).
Howard, J. F. Jr et al. Safety and efficacy of zilucoplan in patients with generalised myasthenia gravis (RAISE): a randomised, double-blind, placebo-controlled, phase 3 study. Lancet Neurol. 22, 395–406 (2023).
Bril, V. 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. 22, 383–394 (2023).
Dalakas, M. C. IgG4-mediated neurological autoimmunities: understanding the pathogenicity of IgG4, ineffectiveness of IVIg and long-lasting benefits of anti-B cell therapies. Neurol. Neuroimmunol. Neuroinflamm. 9, e1116 (2021).
Bril, V. et al. Long-term efficacy and safety of symptom-driven cyclical rozanolixizumab treatment in patients with generalized myasthenia gravis: a pooled analysis of a Phase 3 study and two open-label extension studies. Neurology https://doi.org/10.1212/WNL.0000000000203497 (2023).
Freimer, M. et al. RAISE-XT: An interim analysis of safety and efficacy in an open-label extension of zilucoplan in patients with myasthenia gravis. Neurology https://doi.org/10.1212/WNL.0000000000202910 (2023).
Stathopoulos, P. & Dalakas, M. C. Evolution of anti-B cell therapeutics in autoimmune neurological diseases. Neurotherapeutics 19, 691–710 (2022).
Brauner, S. et al. Comparison between rituximab treatment for new-onset generalized myasthenia gravis and refractory generalized myasthenia gravis. JAMA Neurol. 77, 974–981 (2020).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The author declares no competing interests.
Rights and permissions
About this article
Cite this article
Dalakas, M.C. Advances in the therapeutic algorithm for myasthenia gravis. Nat Rev Neurol 19, 393–394 (2023). https://doi.org/10.1038/s41582-023-00825-y
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41582-023-00825-y