Myasthenia gravis is a chronic condition that doesn’t currently have a cure. Treatment can improve symptoms and overall quality of life. Medications are often a key part of a treatment plan.

Myasthenia gravis (MG) is a chronic autoimmune condition that leads to muscle weakness in your voluntary muscles. These include important muscles in your face, neck, throat, arms, and legs.

A treatment plan for MG usually involves a combination of approaches such as medications, surgery, and complementary therapies. The exact treatment recommendations are based on your individual symptoms and disease progression.

Learn more about the following MG treatment options.

In some cases, your doctor may prescribe more than one MG medication at a time. You can talk with your doctor about the effectiveness, benefits, and potential side effects of the following medications.

Corticosteroids

Corticosteroids are commonly prescribed immunosuppressive therapies for conditions such as MG. The main type of corticosteroid used to treat MG is prednisone (Deltasone, Prednisone Intensol, Rayos).

Prednisone may cause the following side effects:

The longer you take prednisone, the greater the risk of side effects will be. For this reason, you’ll likely take this medication for only a short time.

Your doctor may recommend that you take this medication every other day at first and then gradually taper off the dosage. The average starting dose is 60–100 milligrams.

Immunosuppressants

Immunosuppressants work by targeting the cause of MG at its source: your immune system. By suppressing overactivity in your immune system, these medications may help reduce your symptoms and prevent MG progression.

Common immunosuppressants for MG include:

  • azathioprine (Imuran)
  • cyclophosphamide (Cytoxan, Neosar)
  • cyclosporine (Neoral, Sandimmune,)
  • methotrexate (Otrexup, Trexall, Xatmep)
  • mycophenylate mofetil (CellCept)
  • tacrolimus (Prograf)

Immunosuppressants are taken for a longer period of time than corticosteroids. They may not reach full effectiveness until 3–6 months after you start taking them.

Immunosuppressants have some risks, especially when you take them long term, because they also suppress your body’s ability to fight off everyday infections. A doctor will assess the benefits and possible risks before prescribing these medications and monitor you carefully while you’re taking them.

Side effects may include:

  • an increased chance of contracting infections
  • gastrointestinal issues
  • elevated blood pressure
  • loss of appetite
  • fatigue
  • a general sick feeling (malaise)

Cholinesterase inhibitors

Also known as anticholinesterases, cholinesterase inhibitors are often considered first-line medications for MG. They tend to work quickly and have fewer long-term side effects than corticosteroids or immunosuppressants.

Cholinesterase inhibitors work by preventing your muscles from breaking down acetylcholine, which is necessary for healthy muscle contractions. As a result, they could increase your muscle strength to help you carry out daily activities.

These medications are available in either liquid or tablet form in a drug called pyridostigmine bromide (Mestinon). The effects last a few hours at a time, which means you may need to take the medication several times per day to manage your MG symptoms.

The drawback to cholinesterase inhibitors is that they address only short-term symptoms. Unlike immunosuppressants, these drugs don’t target MG at its source or prevent further progression of the disease.

Possible side effects of this type of medication include:

  • muscle cramps
  • muscle twitching
  • unusual sweating
  • diarrhea
  • abdominal cramps
  • nausea
  • diarrhea
  • increased salivation

It is important to report any concerns to your doctor.

Monoclonal antibodies

Monoclonal antibodies are some of the newest medications used to treat MG.

Eculizumab (Soliris)

This drug helps prevent neuromuscular junction damage. It’s administered weekly for 4 weeks, followed by every 2 weeks, and is approved for people who have tested positive for anti-acetylcholine receptor antibodies.

Taking eculizumab may increase your risk for infections. A doctor may recommend that you take preventive antibiotics and make sure you’re up to date on meningococcal vaccinations before starting this medication.

Rituximab (Rituxan)

Rituxan is a type of monoclonal antibody administered once every 6 months. It suppresses MG activity by targeting B lymphocytes.

Like eculizumab, rituximab increases your risk for infections. In particular, the drug increases the risk for sinus and lung infections and reactivated hepatitis B infections.

Rozanolixizuman-noli (Rystiggo)

The most recently approved monoclonal antibody for MG treatment is rozanolixizuman-noli (Rystiggo). It was approved in 2023 and is administered either directly into your vein (intravenously) or under your skin. Common side effects include:

  • headaches
  • nausea
  • diarrhea

Antibody fragment infusions

In 2021, the Food and Drug Administration (FDA) approved an antibody fragment medication for MG called efgartigimod (Vyvgart). It works by lowering anti-acetylcholine receptor antibodies. Administered intravenously via infusions, efgartigimod is also the first of its kind in a new drug class.

Given the relatively new status of this drug, its effectiveness and risks are still being studied. But upon approving the drug, the FDA noted the following side effects:

New drugs are constantly being studied for potential MG treatment.

One example is a class of medications that target autoantibodies, which are proteins that attack your immune system. Another is vemicropan (ALXN2050), which was last reported to be in phase 2 trials as of November 2023.

Additionally, researchers are investigating possible biomarkers of MG. By testing for these biomarkers early, a doctor may be able to find out which classes of medications may or may not work for you.

Monoclonal antibodies are another class of medications that are continuously being developed for MG, with rozanolixizuman-noli being the most recent addition in 2023.

Aside from medications, you might consider talking with your doctor about other available treatments and strategies for managing MG, such as:

Learn more about myasthenia gravis treatment.

Below are some of the most frequently asked questions about MG treatments. You may wish to discuss these further with your doctor.

What is the newest medication for myasthenia gravis?

While monoclonal antibodies are some of the newest medications approved for MG, there are other exciting recent medical developments. To date, the newest medication for MG is zilucoplan (Zilbrysq), a daily injection that was approved in October 2023.

What is the first drug for myasthenia gravis?

Pyridostigmine bromide (Mestinon), a type of cholinesterase inhibitor, is usually the first drug prescribed for MG. It helps manage muscle weakness by preventing signal disruptions between your muscles and nerves.

What is the best treatment for myasthenia gravis?

There is no single best treatment for MG, and your treatment plan will be highly individualized.

Depending on the severity of your symptoms and your overall condition, a doctor may first recommend cholinesterase inhibitors, as these have the fewest side effects. However, more severe MG may require long-term treatments such as immunosuppressants.

While many medications for MG can cause side effects, they may help reduce your risk of MG-related complications. With treatment, most people with MG have an average life span. There are also new drugs on the horizon that may help treat MG in the future.