New pathogenic treatments for myasthenia gravis

Myasthenia gravis (MG) is an autoimmune disease caused by the production of specific autoantibodies to various components of the neuromuscular synapse, leading to muscle weakness and disabling fatigue. Treatment of MG aims to stop the symptoms and inhibit the triggers of the autoimmune process. For a long time, MG treatment included anticholinesterase agents and nonspecific immunosuppressive and immunomodulatory therapies used alone or in combinations: glucocorticosteroids, cytostatics, plasmapheresis, and intravenous immunoglobulin. Despite the fact that the above drugs are widely used in the treatment of MG, they can cause unacceptable side effects with long-term use and also are not consistent in induction of remission. The search for new effective and safe therapies for MG, especially refractory types that do not respond to standard therapy, is an urgent task. Due to advances in biotechnology and the emergence of new types of drugs, monoclonal antibodies or fusion proteins, targeted MG immunotherapy has been developed for specific pathogenetic targets. The presented review describes targeted MG therapies that are already approved In Russia and other countries, as well as those at different stages of development. Most targeted agents have some advantages over traditional immunosuppressive therapy: rapid onset of action, long-term remission, and minimal side effects. Currently, eculizumab and ravulizumab are approved In Russia.