Myasthenia gravis therapy reference (2026)
Reference snapshot of generalised myasthenia gravis therapy across symptomatic, immunosuppressant, and modern biologic tiers.
Generalised myasthenia gravis therapy in 2026 spans three tiers. Symptomatic: acetylcholinesterase inhibitors (pyridostigmine) remain first-line for symptom control. Background immunosuppression: corticosteroids, azathioprine, mycophenolate, methotrexate, tacrolimus, cyclosporine.
Modern biologic tier: FcRn antagonists (efgartigimod, rozanolixizumab) reduce circulating IgG including pathogenic autoantibodies. Terminal complement inhibitors (eculizumab, ravulizumab, zilucoplan) block complement-mediated neuromuscular damage; primarily for AChR-positive disease. B-cell-targeted approaches (rituximab off-label, inebilizumab in pivotal trials) target the underlying autoantibody-producing cells.
The sequencing question is now the dominant clinical conversation. The biomarker-pathway question (acetylcholine receptor antibody status, MuSK antibody status, antibody titres) is integral to therapy selection across the modern biologic tier.
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