Myasthenia gravis and specific immunotherapy: monoclonal antibodies

Ann N Y Acad Sci. 2019 Sep;1452(1):18-33. doi: 10.1111/nyas.14195. Epub 2019 Aug 8.

Abstract

Myasthenia gravis (MG) is an acquired autoimmune disease affecting the postsynaptic membrane of neuromuscular junctions and characterized by antibody-mediated T cell dependence and complement involvement. Cholinesterase inhibitors (e.g., pyridostigmine bromide), glucocorticoids, and azathioprine are currently recommended as first-line treatments for MG, though they have limitations, including potential toxicity and ineffectiveness in patients with refractory MG. In recent years, owing to an increasing understanding of MG pathogenesis the development and execution of clinical trials with novel biologics, including monoclonal antibodies (mAbs) that have demonstrated higher safety and more specificity, provide new opportunities for the treatment of MG. In this article, we review recent advances in MG pathogenesis and the mAbs that have been used for target-specific MG therapy.

Keywords: biological agents; immunopathology; monoclonal antibody; myasthenia gravis; treatment strategy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antibodies, Monoclonal / therapeutic use*
  • Azathioprine / therapeutic use
  • Cholinesterase Inhibitors / therapeutic use
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Immunotherapy / methods*
  • Myasthenia Gravis / drug therapy*
  • Myasthenia Gravis / immunology
  • Pyridostigmine Bromide / therapeutic use
  • Treatment Outcome

Substances

  • Antibodies, Monoclonal
  • Cholinesterase Inhibitors
  • Immunosuppressive Agents
  • Pyridostigmine Bromide
  • Azathioprine