Use of Targeted Therapies in the Treatment Algorithm of MG

Opinion
Video

Expert neurologists discuss the treatment algorithm of MG, focusing on the use of targeted therapies as well as barriers to their use.

This is a video synopsis/summary of a panel discussion involving James Howard, MD; Nicholas Silvestri, MD, FAAN; Tuan Vu, MD; Ali Habib, MD; and Beth Stein, MD.

The group discusses the integration of targeted therapies in the treatment of myasthenia gravis (MG). The speaker highlights the shift towards introducing these therapies earlier in the treatment paradigm, replacing older therapies like intravenous immunoglobulin (IVIG) with neonatal crystallizable fragment receptor (FcRn) inhibitors due to better insurance coverage, reduced fluid load concerns, and longer effective time windows. She emphasizes a move towards multimodal therapy for rapid symptom control and finding ideal maintenance therapies.

Another speaker describes the evolving treatment approach, initially reserving new medications for patients unresponsive to other treatments. Over time, he has incorporated these therapies earlier to minimize steroid use and associated risks.

Beth advocates for early use of these agents to quickly control the disease and enable patients to return to regular life with minimal side effects. She categorizes treatment options as upstream (eliminating antibody production) and downstream (mitigating antibody effects), noting that downstream treatments have shown more efficacy.

The group agrees on treatment goals of symptom control, minimal side effects, and rapid normalization. Barriers to using these targeted therapies include availability issues, insurance challenges, and administrative hurdles like vaccine adherence requirements. Cost is also a significant concern, with discussions about the total healthcare costs of untreated myasthenia vs the expense of these newer treatments. They stress the need for consensus guidelines to advocate for early aggressive treatment with these newer agents and challenge payers to facilitate patient access.

Video synopsis is AI-generated and reviewed by NeurologyLive editorial staff.

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