Myasthenia Gravis in 2025: five new things and four hopes for the future
Below is a summary of the research article. A WHOLE LOT HAS HAPPENED SINCE 2016! This article explores a decade of research for MG. And wow, it has been a busy decade!
Why This Article Matters
A team of neurologists from the University of Oxford reviewed everything that has changed in the treatment of myasthenia gravis (MG) since 2016 — and the list is long. This is one of the most comprehensive updates the field has seen in years. Here is what matters most to you.
1. Surgery on the Thymus Works — and It’s Getting Gentler
A major clinical trial (called MGTX) confirmed that removing the thymus gland — even when no tumor is present — helps people with AChR-antibody-positive MG. People who had the surgery needed lower steroid doses and experienced fewer day-to-day limitations. Newer minimally invasive techniques (using small incisions and robotic assistance) now mean shorter hospital stays and less pain compared to older open surgery.
Important to know: thymectomy is most supported for people with AChR antibodies. It is not currently recommended for those with MuSK antibodies, because the thymus plays a different role in that form of MG.
2. A Wave of New Medications — Three Different Approaches
Since 2016, the FDA has approved several new treatments for MG. They work in three distinct ways:
| Complement inhibitors | Eculizumab, Ravulizumab, Zilucoplan — these block the part of the immune system that directly damages the nerve-muscle connection. Zilucoplan can be self-injected at home. |
| FcRN inhibitors | Efgartigimod and Rozanolixizumab — these reduce the harmful antibodies circulating in the blood by up to 70%, similar to plasma exchange but as an infusion or injection. Rozanolixizumab is the first FDA-approved treatment specifically for MuSK-antibody MG. |
| B cell depletion | Inebilizumab-cdon (and rituximab not approved by FDA)Removes the immune cells that produce harmful antibodies. Trial results suggest it works best when started early in the disease — a key insight with real implications for treatment timing. |
3. Timing May Be Everything
One of the most striking findings in this review: for at least one treatment (Rituximab), earlier intervention produced better results. In a trial of newly diagnosed people with MG, a low dose started at disease onset led to more people reaching minimal symptoms — outperforming a much higher dose given later in the disease course. Researchers believe starting treatment early may prevent the immune system from entrenching itself. This is an evolving area, but it’s a reason to ask your care team about your treatment timeline.
4. MG in Older Adults Is Getting the Attention It Deserves
More people are being diagnosed with MG later in life — and living with it for decades. The authors flag that older adults often have more complex health pictures, take more medications, and may respond differently to immunosuppression. Current guidelines and most clinical trials have underrepresented this group. Researchers are calling for studies designed specifically with older people in mind.
Four things researchers say they still hope to solve: faster, more reliable diagnosis tools — ways to protect the nerve-muscle connection before damage occurs — better understanding of MG in older adults — and CAR T-cell therapy, a cutting-edge approach that has shown early promise in one small study and may one day offer long-term remission.
You can read the whole article HERE
