Evaluating the Treatment Evolution of Myasthenia Gravis and Use of Immunosuppressants: Nicholas Silvestri, MD, FAAN


The clinical professor of neurology at the University at Buffalo provided insight on the advances in treatment options for patients with myasthenia gravis over the past few decades. [WATCH TIME: 3 minutes]

WATCH TIME: 3 minutes

"I think what’s missed over time is the burden of the treatments we use. What are the side effects to the treatments for myasthenia gravis? You had these situations where patients are doing better from a Myasthenia standpoint but having other symptoms that aren’t acceptable to them."

Over the past century, the prevalence of myasthenia gravis (MG) has increased; however, mortality has declined because of the development of effective treatments. Some of the first treatments for the disease began in the 1930s, followed by more common use of corticosteroids and plasma exchange in the 1960s. Over the past 2 decades, there have been more notable approvals, such as mycophenolate mofetil in 2008, rituximab (Rituxan; Genentech) in 2012, eculizumab (Soliris; Alexion) in 2017, and most recently, ravulizumab (Ultomiris; AstraZeneca) in 2022.

Ravulizumab, FDA-approved in April, became the first long-acting C5 compliment inhibitor for patients with MG, representing another feat for the community. At the 2022 American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) annual meeting, September 21-24, in Nashville, Tennessee, Nicholas Silvestri, MD, presented a talk on the evolution of treatment options for MG, including the common immunosuppressives used. Additionally, he detailed the efficacy and safety profiles of these therapeutics and highlighted how each are used when inadequate responses are found.

Silvestri, a clinical professor of neurology at the University at Buffalo, sat down with NeurologyLive® at AANEM 2022 to discuss his presentation, along with the significant changes in the treatment paradigm, improvements in overall efficacy to these agents, and the need for increased awareness of the negative side effects.

Click here for more coverage of AANEM 2022.

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