Top 10 Myasthenia Gravis Stories of 2022

Myasthenia Gravis News has brought you up-to-date coverage of the latest scientific research and developments in treatment related to myasthenia gravis (MG) throughout 2022.

We look forward to continuing to serve as a resource for patients and their families, caregivers, clinicians and physicians, researchers, advocates, industry leaders, scientists and educators in the new year. Here are the 10 most-read articles published in 2022, along with a brief description of what made them relevant for our readers.

No. 10 — “Risk Factors for MG Exacerbations, Myasthenic Crises ID’d in Study”

People with MG may experience episodes in which symptoms suddenly worsen, such as disease exacerbations and myasthenic crises. A team led by scientists in Germany analyzed data from more than 800 patients to identify risk factors for these episodes. The results indicated that the risk was higher for patients with more severe disease at diagnosis and for those with generalized MG. Other risk factors included the presence of a thymoma, or a tumor in the thymus gland, or anti-MuSK antibodies. Researchers emphasized the importance of appropriate monitoring for these complications.

No. 9 — “Chinese Medicine May Ease MG by Acting On Gut Microbiota”

Fufang Huangqi decoction is a concentrated liquid derived from several roots and herbs that is commonly used in traditional Chinese medicine. Some early research suggested this herbal preparation might help ease MG symptoms in some patients, but the potential mechanism has been unclear. Here, researchers analyzed the makeup of gut bacteria in eight people with mild MG who reported benefits from Fufang Huangqi, as well as eight people who had not been given the Chinese medicine. Results indicated that patients who took Fufang Huangqi had fewer pro-inflammatory gut bacteria and a higher number of beneficial microbes, suggesting the herbal therapy may help restore gut microbial balance.

No. 8 — “Spherix Analyzes Reviews of gMG Therapies, Vyvgart, Ultomiris”

Vyvgart (efgartigimod) and Ultomiris (ravulizumab-cwvz) both were approved in the U.S. in recent years to treat generalized MG. The market intelligence firm Spherix Global Insights conducted an analysis comparing these therapies, which have different mechanisms of action. Both were found to be generally effective. Ultomiris, which is administered via infusion every eight weeks, was viewed as having a more convenient dosing schedule than Vyvgart, where dosing can be variable. However, Vyvgart was found to have a better safety profile, with less risk for the serious infections that have been reported on Ultomiris.

No. 7 — “Case Report Shows MG May Occur With Rare Miller Fisher Syndrome”

Miller Fisher syndrome, a variant of Guillain-Barré syndrome, is an autoimmune disease that can cause muscle weakness similar to that of MG. But while MG is caused by self-reactive antibodies that attack proteins on muscle tissue, Miller Fisher syndrome is driven by antibodies that attack nerve cells. Here, researchers in China described the case of a 58-year-old man who suddenly began experiencing symptoms like dizziness, numbness in the limbs, drooping eyelids, and slurred speech. A battery of clinical evaluations revealed that he had both MG and Miller Fisher syndrome, an extremely rare phenomenon. The man was given treatments to address both conditions, and his symptoms eased substantially.

No. 6 — “Immunovant to Launch US Phase 3 Trial for Batoclimab in MG”

Batoclimab, also known as IMVT-1401, is an experimental therapy designed to lower the levels of the self-reactive antibodies that drive MG. Its developer, Immunovant, announced at the start of the year that it planned to launch a Phase 3 trial (NCT05403541) to test two doses of batoclimab against a placebo in adults with generalized MG. The study will continue through 2025; it is still recruiting participants at several U.S. sites. The trial’s main goal is to compare the effects of treatment on disease activity after 12 weeks, or about three months.

No. 5 — “MG at Advanced Stage Follows Thymus Surgery in Older Man”

The thymus gland is an immune organ in the chest. Thymectomy, or the surgical removal of the thymus, is an important tool for treating MG. But in rare cases, MG can develop following this surgical procedure. That’s what happened to a 70-year-old man in China, who underwent thymectomy due to a tumor in the thymus. A few days after surgery, the man was treated at the hospital for breathing difficulties that required ventilation. He was initially diagnosed and treated for a bacterial lung infection, which improved his condition somewhat, but he still needed ventilation. Further diagnostic testing revealed he had developed MG, which had rapidly become very severe. With appropriate treatment, he was able to be weaned off mechanical ventilation.

No. 4 — “Argenx Gears Up for US Launch of Vyvgart, Awaiting EU Decision”

After Vyvgart was approved in the U.S. in late 2021, its developer, Argenx, announced plans to work toward the therapy’s commercial launch in the U.S. At the time, applications for Vyvgart were under review in Japan and Europe — both of which have since been approved. Argenx has selected the specialty pharmacy Soleo Health as the U.S. distributor for Vyvgart.

No. 3 — “3 Cases of MG Possibly Caused by COVID-19 Vaccination: Report”

A team of scientists in Italy reported three cases of men who developed MG shortly after being vaccinated for COVID-19. The scientists stressed that it was impossible for them to say with certainty whether the vaccine caused MG in these three men, or if the diagnosis of MG around the time of vaccination was a coincidence. Given that vaccines work by activating the immune system and MG is caused by immune overactivity, the team said it was “conceivable” that the vaccine might have prompted MG to develop. Yet, they also pointed out that it’s “most likely” that vaccination might have triggered an exacerbation of disease that was already present in a very mild state.

No. 2 — “Anti-thyroid Antibodies Tied to Specific Immune Profile in MG”

Autoimmune thyroid diseases or ATDs — autoimmune conditions characterized by self-reactive antibodies that attack healthy parts of the thyroid gland — commonly occur alongside MG. Although thyroid-targeting antibodies are detectable in up to 30% of MG patients, the impact these antibodies have on the immune system of MG patients is not fully understood. To learn more, scientists analyzed data from 48 MG patients, 15 of whom had anti-thyroid antibodies. The team found that patients with anti-thyroid antibodies had higher level of B-cells — the immune cells mainly responsible for antibody production. Yet, at the same time, these patients had lower levels of MG-driving antibodies. Patients with anti-thyroid antibodies also had lower counts of T-cells, another type of immune cells. Based on these observations, the researchers hypothesized that MG patients with anti-thyroid antibodies may benefit more from B-cell-targeted therapies.

No. 1 — “Despite Side Effects, Pyridostigmine Perceived as Moderately Effective”

Pyridostigmine (sold as Mestinon, among other brand names) is an oral medication commonly used as a first-line treatment for MG. It was approved in the U.S. in the 1950s, before the modern concept of clinical trials, and is used in many countries worldwide. Now, to learn more about the therapy’s effects, researchers conducted a survey of nearly 400 Dutch MG patients, most of whom had been treated with pyridostigmine at some point. Results showed that pyridostigmine was perceived as being moderately effective, with a median overall effectiveness rating of 60 out of 100. The therapy also was commonly associated with side effects, such as digestive problems, muscle cramps, blurred vision, and flu-like symptoms. Overall, researchers said these findings do not indicate a need for changes to current treatment guidelines.

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We look forward to continuing to bring you the latest news about MG in 2023, and we wish all of our readers a very happy new year!