Treatment strategies for myasthenia gravis: an update

Introduction: New treatments for immune mediated diseases have increased notably in the last 10 years. Monoclonal antibodies directed against different components of the immune system have appeared, along with new drugs from the haematology field. In the case of myasthenia gravis (MG), many of these new treatments have been used in experimental animal models and also in patients. Areas covered: This manuscript reviews the progress in the field of MG treatment achieved in the last 5 years. Firstly, our current treatment protocol is introduced. Secondly, new data from recent randomized trials and case series of patients treated with methotrexate, cyclophosphamide, rituximab or improved systems of apheresis is reported. Finally, all future treatments are discussed that are currently under evaluation in preclinical animal models of experimental autoimmune MG. Expert opinion: Evidence supporting the use of methotrexate and rituximab in MG has been published recently, in addition to conflicting randomized trials that were not successful, evaluating the use of tacrolimus as a steroid sparing agent. New promising treatments are currently under evaluation in clinical trials, such as belimumab and eculizumab.