By Leanne Edwards, BSN, RN, IgCN, Clinical Nurse Educator - June 22, 2026
Understanding Treatment Options in Myasthenia Gravis
Myasthenia gravis (MG) is a rare chronic autoimmune disorder that causes muscle weakness that worsens with activity and improves with rest. While this condition can affect any voluntary muscles, it most commonly impacts muscles in the eyes, neck, face, throat, arms, and legs. MG occurs when antibodies interfere with the communication between nerves and muscles stopping the muscle function. Treatment options have evolved significantly, and a range of therapies is now available, including traditional immunosuppressants and newer targeted biologics.
Specialty infusion providers, such as Nufactor, play an important role in supporting safe therapy administration, clinical monitoring, and patient education.
For this overview, I am separating the treatments into two categories: long-term therapies for generalized MG (gMG) and rapid-acting therapies used during exacerbations.
Traditional Therapies for Generalized MG
Initial treatment often includes corticosteroids, such as prednisone, to reduce immune system activity and improve symptoms. While effective, long-term use requires careful monitoring due to the potential for adverse effects such as weight gain, high blood sugar (which can start diabetes or make it worse), higher risk of infections, and osteoporosis.
Steroid-sparing immunosuppressants are commonly used to support longer-term disease control, including:
- Azathioprine
- Mycophenolate mofetil
- Cyclosporine
- Tacrolimus
These therapies help suppress the underlying immune response but may take six months to a year to reach full effectiveness. Ongoing clinical monitoring is important to manage infection risk and potential medication-related toxicities.
Symptomatic treatments such as pyridostigmine may also be used to improve muscle strength, but they do not address the underlying immune response.
Targeted Biologic Therapies for Generalized MG
Advances in immunology have introduced more targeted treatment options, particularly for patients with moderate to severe or refractory MG. These therapies act on specific pathways involved in disease progression.
Complement Inhibitors
- Soliris® (eculizumab)
- Ultomiris® (ravulizumab)
The precise mechanism by which these therapies exerts its therapeutic effect in generalized MG patients is unknown, but is presumed to involve reduction of terminal complement complex C5b-9 deposition at the neuromuscular junction. Soliris is typically administered intravenously with a weekly dose for 5 weeks followed by infusions every 2 weeks. Ultomiris offers extended dosing intervals of every 4 or 8 weeks that may reduce treatment frequency.
Because complement inhibition increases the risk of meningococcal infection, appropriate vaccination prior to treatment and ongoing monitoring are important.
FcRn Inhibitors
- Vyvgart® (efgartigimod IV)
- Vyvgart Hytrulo® (subcutaneous)
- Rystiggo® (rozanolixizumab, subcutaneous)
- Imaavy® (nipocalimab, IV)
These therapies reduce circulating IgG antibodies by blocking the neonatal Fc receptor, helping decrease the antibodies associated with MG symptoms.
Administration varies by therapy. Intravenous treatments are typically given in cycles, while subcutaneous options may offer added flexibility. Monitoring for infection and hypersensitivity reactions remains important.
Additional Targeted Options
Other therapies further expand treatment flexibility and allow for individualized care:
- Zilbrysq® (zilucoplan), a subcutaneous complement inhibitor
- Rituxan® (rituximab), a B-cell depleting therapy used in select patients
- Uplizna® (inebilizumab), a therapy targeting CD19-positive B cells
Therapy selection depends on disease severity, antibody status, and prior treatment response.
MG Exacerbation
In certain situations, such as significant disease exacerbation or myasthenic crisis, more rapid symptom control may be needed.
Signs and Symptoms of MG Exacerbation:
- Worsening eyelid drooping or double vision
- Increased difficulty chewing or swallowing
- More slurred or nasal-sounding speech
- Neck weakness (“head drop”)
- Arm or leg weakness that’s noticeably worse than usual
- Shortness of breath or difficulty breathing
When breathing or swallowing becomes affected, this can progress to a myasthenic crisis, which may require urgent treatment or hospitalization.
Rapid-Acting Therapies for MG Exacerbation:
Intravenous immunoglobulin (IVIG) and plasma exchange are commonly used in these settings or as a bridge to long term treatment.
- IVIG is administered as an infusion over several days and is thought to work by modulating the immune system.
- Plasma exchange removes circulating antibodies from the bloodstream.
These therapies are typically used for short-term management and require close monitoring during administration.
Surgical Option: Thymectomy
For some patients, thymectomy remains an important treatment consideration. Removal of the thymus gland may improve symptoms, reduce reliance on long-term immunosuppressive therapy, and in some cases contribute to sustained remission.
Decisions are individualized based on patient-specific factors.
The Role of Infusion and Clinical Support
Many MG therapies require specialized administration, making infusion providers a key part of the care team.
Nufactor-aligned best practices include:
- Pre-infusion screening for infections, prior reactions, and overall clinical status
- Monitoring of vital signs during and after therapy
- Availability of medications to manage infusion-related reactions if needed
- Ongoing patient education on treatment expectations, potential side effects, and adherence
This structured approach supports patient safety, consistency of care, and an improved overall treatment experience.
Conclusion
The management of MG includes a broad range of options, such as corticosteroids, traditional immunosuppressants, targeted biologics, rapid-acting therapies, and surgical intervention.
Therapies such as Soliris®, Ultomiris®, Vyvgart®, Vyvgart Hytrulo®, Rystiggo®, Imaavy®, Zilbrysq®, Rituxan®, and Uplizna® allow providers to tailor treatment plans based on individual patient needs.
As these therapies continue to evolve, infusion providers like Nufactor remain essential in supporting safe administration, monitoring, and patient-centered care to help improve outcomes and quality of life.
References
