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How Is Myasthenia Gravis Treated?

The goal of treating myasthenia gravis is to reduce or improve muscle weakness without the treatment causing side effects. Some people’s symptoms can improve to the point that they may only feel weakness on occasion, while some people struggle to find a treatment that works for them. Some people even go into remission, which means they have no signs or symptoms of MG.

There are several ways to treat myasthenia gravis. These treatments help control muscle weakness and calm the immune system. These treatments include:1

  • Acetylcholinesterase inhibitors
  • Steroids and other immunosuppressants
  • Plasmapheresis
  • Intravenous immunoglobulin (IVIG)
  • Thymectomy
  • Lifestyle and alternative treatments
  • Biologics

It may take some time to find the right combination of treatments that work. That is because MG can be very different from person to person and no one treatment works for everyone.

Acetylcholinesterase inhibitors

Acetylcholinesterase inhibitors are a type of drug that improves nerve signals to the muscles. This drug can be taken once, twice, or several times a day, depending on your symptoms. Pyridostigmine (Mestinon) is the drug usually recommended for people with MG.1,2

Steroids and other immunosuppressants

Steroids are drugs that help calm an overactive immune system. Steroids (also called glucocorticoids) may be added if your muscle weakness does not get better after taking acetylcholinesterase inhibitors.

Some people cannot take steroids or need a stronger drug to calm their immune system. If that happens to you, your doctor can prescribe other kinds of drugs that suppress the immune system. These drugs are called immunosuppressants and include:1

  • Azathioprine (Azasan, Imuran)
  • Cyclosporine (Gengraf, Neoral, Sandimmune)
  • Methotrexate (Rheumatrex, Trexall)
  • Mycophenolate mofetil (CellCept, Myfortic)
  • Tacrolimus (Astagraf XL, Envarsus XR, Prograf)

Plasmapheresis

Plasma is one of the building blocks of blood. Among its many jobs, plasma carries antibodies, which are chemicals the body makes to fight germs. In an autoimmune condition like MG, abnormal antibodies attack healthy tissue. Plasmapheresis is a process in which a machine removes the abnormal antibodies in your plasma and replaces it with healthy plasma.1

Plasmapheresis is most often used when symptoms are temporarily severe. It can also be used on a regular basis if someone’s MG is more serious or not responding to other treatments. Plasmapheresis starts to work in days but the effects are temporary, usually lasting for weeks.1

Intravenous immunoglobulin (IVIG)

IVIG is an injection (also called an IV) filled with healthy antibodies. IVIG is most often given to people who have severe symptoms for a short period of time. It is a treatment that helps reduce the body’s attack on the nervous system. This is another treatment that can also be used on a regular basis if someone’s MG is more serious or not responding to other treatments. LIke plasmapheresis, it begins working in days and brings temporary relief for a few weeks.1

Thymectomy

Thymectomy is a surgery to remove the thymus gland. This surgery is not an option for everyone with MG, and it may not always improve symptoms. It is recommended for people with thymoma, a tumor on the thymus gland. Sometimes it is also a treatment option for people with MG who do not have a thymoma.1

Lifestyle and alternative treatments

Diet, exercise, rest, and stress reduction can all help manage the symptoms of myasthenia gravis. Knowing your personal triggers can also help reduce flares. Things known to trigger MG symptoms include:3

  • Drinking alcohol
  • Emotional stress
  • Foods that require a lot of chewing
  • Forgetting to take your MG drugs
  • Hot foods
  • Large meals
  • Other illness, such as the flu, surgery, or heart or kidney problems
  • Taking certain over-the-counter or prescription drugs
  • Too much exercise, or “powering through” when you are tired
  • Warm weather

Biologics

About 1 out of 10 people with generalized MG develop what is called refractory MG. Refractory MG is a serious condition in which symptoms do not improve after the use of steroids and other immunosuppressants, IVIG, and plasmapheresis. In these cases, doctors may prescribe biologics. These are a type of drug made from living organisms that help suppress the immune system.4

The biologic eculizumab (Soliris) may be prescribed to people with AChR-positive refractory MG. The biologic rituximab (Rituxan) may be given to people with MuSK-positive refractory MG. Both are given by IV.4

Things to know about MG treatments

Certain types of people with myasthenia gravis may need other treatments. This includes children, women who are pregnant, the elderly, and people with rare subtypes of MG.

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Written by: Jessica Johns Pool | Last reviewed: August 2020