A Review of Disease Mechanisms and Current and Emerging Treatment Options for Generalized Myasthenia Gravis

Overview

Patients with generalized myasthenia gravis (gMG) receive multiple immunosuppressive therapies, but with incomplete suppression of IgG autoantibodies. Review this update on gMG to learn about novel therapies that can more effectively suppress IgG autoantibodies through a novel mechanism of action to help your patients achieve better clinical outcomes.

Learning objectives

  • Consider actions of novel medications in treatment decisions for patients with gMG (including IgG and AChR antibodies, FcRn modulation)
  • Counsel patients on the changing landscape of gMG treatment
  • Incorporate evidence on efficacy and safety into the process of tailoring appropriate therapies for patients with gMG, both with current treatments and as novel ones become available

Target Audience

Neurology, neuromuscular, neuroimmunology, and neuro-ophthalmology advanced care practitioners

Abstract

Generalized myasthenia gravis (gMG) is a disease resulting from impaired neuromuscular transmission due to presence of antibodies that block acetylcholine receptors. Autoantibodies to acetylcholine receptors directly impair the activity of ion channels that conduct nerve impulses, and cross-link acetylcholine receptors resulting in complement-mediated destruction, further worsening functional impairment and patient quality of life. Although current treatments for gMG include thymectomy, immunosuppressive therapies, intravenous immunoglobulins, and plasmapheresis, among other strategies, none of these treatments reduces all immunoglobulin G subfractions. However, with the novel neonatal Fc receptor antagonist efgartigimod, levels of all immunoglobulin G subfractions are reduced, addressing an important aspect of the underlying pathophysiology of gMG. Through this program, clinicians will consider novel mechanisms in gMG therapy, learn to counsel patients on the changing landscape of gMG therapies, and find ways to incorporate the latest efficacy and safety data into practice.

From the Series: Like a Game of Chess, Every Move Matters: The Role of Antibodies in the Myasthenia Gravis Treatment Landscape

To cite: Barnett-Tapia C, Bril V, and Silvestri NJ. A Review of Disease Mechanisms and Current and Emerging Treatment Options for Generalized Myasthenia Gravis. Prim Care Companion CNS Disord. 2022;24(3):AR21018WC2C.

To share: https://doi.org/10.4088/PCC.AR21018WC2C

© Copyright 2022 Physicians Postgraduate Press, Inc.

Target Audience

Neurology, neuromuscular, neuroimmunology, and neuro-ophthalmology advanced care practitioners

Learning Objectives

  • Consider actions of novel medications in treatment decisions for patients with gMG (including IgG and AChR antibodies, FcRn modulation)
  • Counsel patients on the changing landscape of gMG treatment
  • Incorporate evidence on efficacy and safety into the process of tailoring appropriate therapies for patients with gMG, both with current treatments and as novel ones become available

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Like a Game of Chess, Every Move Matters: The Role of Antibodies in the Myasthenia Gravis Treatment Landscape
Symptoms and disease pathophysiology of myasthenia gravis (MG) vary considerably with each patient, and their individual preferences and priorities add to the need for individualized treatment of this autoimmune disease. Research in MG has grown substantially in recent years. New treatments have the potential of being both effective and well tolerated, addressing the trade-off of choosing either efficacy or tolerability when selecting treatments. Promising investigational treatments that may become available in the future may allow more patients than ever before to achieve an asymptomatic state, with the ultimate goal being to turn off abnormal antibody production.
Activity summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation
Activity opens: 
04/08/2022
Activity expires: 
04/30/2023
Cost:
$0.00

Support Statement

Supported by an educational grant from argenx.

Learning Objective

After completing this educational activity, you should be able to:

  • Consider actions of novel medications in treatment decisions for patients with gMG (including IgG and AChR antibodies, FcRn modulation)
  • Counsel patients on the changing landscape of gMG treatment
  • Incorporate evidence on efficacy and safety into the process of tailoring appropriate therapies for patients with gMG, both with current treatments and as novel ones become available

Release, Review, and Expiration Dates

This CME activity was published in April 2022 and is eligible for AMA PRA Category 1 Credit™ through April 30, 2023. The latest review of this material was March 2022.

Statement of Need and Purpose

Treatment of gMG is not one-size-fits-all because of patients’ varied symptoms and disease pathophysiology. Despite numerous available therapies, the current treatment landscape for gMG has left many patients with unmet efficacy needs and considerable side effect burden. Research in gMG has grown substantially in recent years. Clinicians need awareness of disease mechanisms and education on the efficacy and safety of current and emerging therapies to improve outcomes for patients with gMG. This activity was designed to meet the needs of participants in CME activities provided by the CME Institute of Physicians Postgraduate Press, Inc., who have requested information on myasthenia gravis.

Disclosure of Off-Label Usage

The faculty members have determined that, to the best of their knowledge, corticosteroids, azathioprine, mycophenolate, methotrexate, cyclosporine, tacrolimus, IVIG, SCIG, PLEX, rituximab, rozanolixizumab, zilucoplan, nipocalimab, and RVT-1401 are not approved by the US Food and Drug Administration for the treatment of myasthenia gravis.

Review Process

The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.

Acknowledgment

This CME activity is derived from the planning series “Like a Game of Chess, Every Move Matters: The Role of Antibodies in the Myasthenia Gravis Treatment Landscape,” which was held in October 2021 and supported by an educational grant from argenx. The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter.

Faculty Affiliation


Vera Bril, MD, FRCPC
Division of Neurology, University of Toronto and University Health Network

 


Nicholas J. Silvestri, MD, FAAN
University at Buffalo Jacobs School of Medicine and Biosciences, New York

 


Carolina Barnett-Tapia, MD, PhD
Division of Neurology, University of Toronto and University Health Network

 


Financial Disclosure

The faculty for this CME activity and the CME Institute staff were asked to complete a statement regarding all relevant personal and financial relationships between themselves or their spouse/partner and any commercial interest. The Accreditation Council for Continuing Medical Education (ACCME) defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosure is as follows:

Dr Brill has served as a consultant for argenx, Alexion, Alnylam, Ackea, Ionis, Immunovant, Sanofi, Roche, UCB, Momenta, CSL, Takeda, Octapharma, NovoNordisk, Grifols, Janssen; received grant/research support from argenx, Alexion, UCB, Takeda, CSL, Immunovant, Momenta, Ionis, Pharnext; received honoraria from argenx, Alexion, Alnylam, Ackea, Immunovant, Momenta, Ionis, Pharnext; and has served on speakers/advisory boards for argenx, Alexion,  Alnylam, Ackea, Ionis, Immunovant, Sanofi, Roche, UCB, Momenta, CSL, Takeda, Octapharma, NovoNordisk, Grifols, Janssen. Dr Silvestri has served as a consultant for argenx and has served on speakers/advisory boards for Alexion, argenx, Immunovant, UCB, and Strongbridge. Dr Barnett-Tapia has served as a consultant for argenx and Alexion; received grant/research support from the US Department of Defense, MGNet, Muscular Dystrophy Canada, and Grifols; served on the speaker/advisory board for Sanofi; and is the primary developer of the Myasthenia Gravis Impairment Index (MGII) and may receive royalties in the future..

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation

Price

Cost:
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Available credit: 

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation

Learning objectives

  • Consider actions of novel medications in treatment decisions for patients with gMG (including IgG and AChR antibodies, FcRn modulation)
  • Counsel patients on the changing landscape of gMG treatment
  • Incorporate evidence on efficacy and safety into the process of tailoring appropriate therapies for patients with gMG, both with current treatments and as novel ones become available

Target Audience

Neurology, neuromuscular, neuroimmunology, and neuro-ophthalmology advanced care practitioners