Welcome

Myasthenia gravis (MG) is a rare, chronic antibody-mediated disorder that results in impaired neuromuscular transmission, manifesting as muscle weakness and fatigue¹. Over the past 2 decades, extensive research has shed light on the pathophysiology and immunopathology of MG, transforming it from a niche neurological condition to a well-defined autoimmune disease. Various treatments with promising outcomes are now accessible – with more in development – and their potential impact extends beyond MG to other autoimmune disorders².

In this Learning Zone, explore:

• the critical role in identifying early symptoms to improve early diagnosis of MG
• the current treatment landscape and information about the latest findings in new therapy pathways
• the currently available options in clinical practice for complicated cases of MG

While MG is most commonly diagnosed in adulthood, the onset of symptoms can occur at any age, including childhood and old age³

Myasthenia gravis (MG) is an autoimmune condition characterised by the targeting of components of the neuromuscular endplate by autoantibodies, most commonly against acetylcholine receptors⁴. This immune response leads to a disruption in the generation of endplate potentials, hindering the ability to initiate muscle contractions effectively⁴. MG can have a significant impact on a person's quality of life, making it difficult to perform daily activities and participate in social events^2,3,5. With early diagnosis and correct treatment, many people with MG are able to manage their symptoms and lead a relatively normal life^3,6, although they often experience a persistently high disease burden despite treatment⁷. Treatment options may include acetylcholinesterase inhibitors to improve nerve transmission to the muscles, immunosuppressive therapy to reduce the abnormal immune response and thymectomy in severe cases².

Meet the expert

Meet Professor Heinz Wiendl, founder and principal investigator of the Body & Brain Institute Münster.

Professor Heinz Wiendl has served as the head of neurology at University Hospital Muenster since 2013. Professor Wiendl’s research focuses on inflammatory neurodegeneration and immune regulation. Professor Wiendl has been widely recognised for his accomplishments; in 2017 he was appointed an honorary professor at Sydney Medical school and in 2021 received an honorary doctorate and professorship from Mashhad University.

Professor Wiendl served as a principal investigator for or coordinated ≥40 phase 1–4 clinical trials. Since 1998, he has authored more than 650 peer-reviewed publications in high-impact journals (H index = 73, approx. 1,500 citations/year), 4 books (editor) and several book chapters.

Disclosures

Professor Wiendl has received honoraria as a member of scientific advisory boards from AbbVie, Alexion, argenx, Bristol Myers Squibb/Celgene, Janssen, Merck, Novartis, and Sandoz. He has also received speaker honoraria and travel support from Alexion, Biogen, Bristol Myers Squibb, Genzyme, Merck, Neurodiem, Novartis, Ology Bioservices, Roche, TEVA, and WebMD Global.

Professor Wiendl is a paid consultant for AbbVie, Actelion, argenx, BD, Biogen, Bristol Myers Squibb, EMD Serono, Fondazione Cariplo, Gossamer Bio, Idorsia, Immunic, Immunovant, Janssen, Lundbeck, Merck, NexGen, Novartis, PSI CRO, Roche, Sanofi, Swiss Multiple Sclerosis Society, UCB and Worldwide Clinical Trials.

His research is funded by the Deutsche Forschungsgesellschaft (DFG), Deutsche Myasthenie Gesellschaft e.V., European Union, Alexion, Amicus Therapeutics Inc., argenx, Biogen, CSL Behring, F. Hoffmann – La Roche, Genzyme, Merck KgaA, Novartis, Roche, and UCB.

References

1. Gilhus NE, Verschuuren JJ. Myasthenia gravis: subgroup classification and therapeutic strategies. Lancet Neurol. 2015;14(10):1023-1036.
2. Evoli A, Damato V. Conventional and emerging treatments and controversies in myasthenia gravis. Expert Rev Neurother. 2023;May 3:1-12.
3. Narayanaswami P, Sanders DB, Wolfe G, Benatar M, Cea G, Evoli A, et al. International consensus guidance for management of myasthenia gravis: 2020 update. Neurology. 2021;96(3):114-122.
4. Dresser L, Wlodarski R, Rezania K, Soliven B. Myasthenia gravis: epidemiology, pathophysiology and clinical manifestations. Journal of clinical medicine. 2021;10(11):2235.
5. Nair SS, Jacob S. Novel immunotherapies for myasthenia gravis. Immunotargets Ther. 2023;12:25-45.
6. Dixon LB, Holoshitz Y, Nossel I. Treatment engagement of individuals experiencing mental illness: review and update. World Psychiatry. 2016;15(1):13-20.
7. Berrih-Aknin S, Palace J, Meisel A, Claeys KG, Muppidi S, Saccà F, et al. Patient-reported impact of myasthenia gravis in the real world: findings from a digital observational survey-based study (MyRealWorld MG). BMJ Open. 2023;13(5):e068104.