Individualized sequencing of targeted immunotherapies in generalized myasthenia gravis across distinct patient profiles
Year: 2026
Type: article
Study design: Case Report
Abstract: Background: Targeted immunotherapies have expanded treatment options for acetylcholine receptor antibody-positive generalized myasthenia gravis (gMG), but evidence regarding their sequencing and individualized therapeutic pathways remains limited. Methods: We describe seven selected adults with AChR-positive gMG managed through individualized targeted-treatment pathways involving administered and, in some cases, planned sequential therapy. Treatment selection was guided by disease severity, corticosteroid-related risks, presence of thymoma, comorbidities, peripheral venous access and the need for rapid clinical improvement and/or sustained disease management. Results: Across the seven cases, FcRn antagonists were used for rapid symptom control, corticosteroid dose reduction and bridging therapy while the appropriate vaccinations required before planned complement inhibition or B-cell depletion therapy were completed. Rituximab was selected as a long-term B-cell-directed immunosuppressive strategy, particularly in recent-onset gMG. Ravulizumab was planned as a long-term, non-steroidal immunosuppressive therapy in thymoma-associated myasthenia gravis and in chronic gMG with symptoms refractory to conventional non-steroidal immunosuppressive therapy and dependent on corticosteroids. Conclusion: These seven cases illustrate how targeted immunotherapies may be used sequentially and individualized according to their onset of action, MG subgroup, treatment goal, required vaccinations and route of administration.
Source: Frontiers in Neurology
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7222408328