Navigating the Expanding Treatment Landscape in Generalized Myasthenia Gravis

Neuromuscular Insights, developed in collaboration with the UCSF Department of Neurology, is a clinician-focused series that brings together leading experts to discuss advances in neuromuscular disease research and patient care. Through practical conversations with specialists from across the field, the series explores evolving treatment strategies, diagnostic challenges, and emerging evidence that can help inform real-world neurological practice.

In Episode 2, released in recognition of MG Awareness Month, Pritikanta Paul, MD, MBBS, Assistant Professor of Clinical Neurology at the UCSF Department of Neurology, is joined by Miriam Freimer, MD, Professor of Neurology at The Ohio State University, for an in-depth discussion on navigating today's rapidly expanding treatment landscape for generalized myasthenia gravis (gMG). With multiple targeted therapies now available, the conversation examines how clinicians can individualize treatment selection by balancing disease severity, antibody status, comorbidities, patient preferences, insurance considerations, and the practical differences between FcRn inhibitors, complement inhibitors, B-cell therapies, and conventional immunosuppressive agents.

Throughout the episode, Freimer shares practical insights on defining treatment success, determining when to switch therapies, managing prednisone exposure, and incorporating newer agents into long-term care. The discussion also explores emerging questions surrounding combination therapy, rescue treatment during myasthenic crisis, and ongoing clinical trials evaluating treatment sequencing and novel approaches such as B-cell modulation and CAR-T therapy. The episode concludes with a forward-looking discussion on remaining research gaps and the continued role of thymectomy as treatment options for gMG continue to evolve.

Episode Breakdown

• 0:00 – Welcome and overview of today's gMG treatment landscape
• 1:15 – Choosing first-line therapy and individualizing treatment decisions
• 8:10 – Defining treatment success and when to consider switching therapies
• 15:25 – Drug interactions, combination therapy, and minimizing prednisone exposure
• 22:05 – Personalizing therapy across FcRn, complement, and B-cell targeted treatments
• 25:55 – Emerging therapies, research priorities, and the future of gMG care
• 28:45 – The continuing role of thymectomy and closing remarks