Editing Myasthenia gravis (section)

===Medication===
[[File:Neostigmine.svg|thumb|Neostigmine, chemical structure]]
[[File:Azathioprine.svg|thumb|Azathioprine, chemical structure]]
About 10% of people with generalized MG are considered [[Disease#Refractory disease|treatment-refractory]].<ref>{{Cite journal |vauthors=Suh J, Goldstein JM, Nowak RJ |date=June 2013 |title=Clinical characteristics of refractory myasthenia gravis patients |journal=The Yale Journal of Biology and Medicine |volume=86 |issue=2 |pages=255–60 |pmc=3670444 |pmid=23766745}}</ref> Autologous [[hematopoietic stem cell transplantation]] (HSCT) is sometimes used in severe, treatment-refractory MG. Available data provide preliminary evidence that HSCT can be an effective therapeutic option in carefully selected cases.<ref>{{Cite journal |vauthors=Burman J, Tolf A, Hägglund H, Askmark H |date=February 2018 |title=Autologous haematopoietic stem cell transplantation for neurological diseases |journal=Journal of Neurology, Neurosurgery, and Psychiatry |volume=89 |issue=2 |pages=147–155 |doi=10.1136/jnnp-2017-316271 |pmc=5800332 |pmid=28866625}}</ref>

[[Efgartigimod alfa]] (Vyvgart) was approved for medical use in the United States in December 2021.<ref name="FDA PR 20211217">{{citation-attribution|1={{Cite press release |title=FDA Approves New Treatment for Myasthenia Gravis |date=17 December 2021 |url=https://www.fda.gov/news-events/press-announcements/fda-approves-new-treatment-myasthenia-gravis |access-date=21 December 2021 |url-status=live |archive-url=https://web.archive.org/web/20211220222022/https://www.fda.gov/news-events/press-announcements/fda-approves-new-treatment-myasthenia-gravis |archive-date=20 December 2021 |website=U.S. [[Food and Drug Administration]] (FDA)}} }}</ref><ref>{{Cite press release |title=Argenx Announces U.S. Food and Drug Administration (FDA) Approval of Vyvgart (efgartigimod alfa-fcab) in Generalized Myasthenia Gravis |date=17 December 2021 |url=https://www.argenx.com/news/argenx-announces-us-food-and-drug-administration-fda-approval-vyvgarttm-efgartigimod-alfa-fcab |access-date=21 December 2021 |url-status=live |archive-url=https://web.archive.org/web/20211220195236/https://www.argenx.com/news/argenx-announces-us-food-and-drug-administration-fda-approval-vyvgarttm-efgartigimod-alfa-fcab |archive-date=20 December 2021 |website=Argenx}}</ref><ref>{{Cite press release |title=argenx Announces U.S. Food and Drug Administration (FDA) Approval of Vyvgart (efgartigimod alfa-fcab) in Generalized Myasthenia Gravis |date=17 December 2021 |publisher=Argenx |url=https://www.businesswire.com/news/home/20211217005641/en/argenx-Announces-U.S.-Food-and-Drug-Administration-FDA-Approval-of-VYVGART%E2%84%A2-efgartigimod-alfa-fcab-in-Generalized-Myasthenia-Gravis |via=Business Wire |access-date=21 December 2021 |url-status=live |archive-url=https://web.archive.org/web/20211219122355/https://www.businesswire.com/news/home/20211217005641/en/argenx-Announces-U.S.-Food-and-Drug-Administration-FDA-Approval-of-VYVGART%E2%84%A2-efgartigimod-alfa-fcab-in-Generalized-Myasthenia-Gravis |archive-date=19 December 2021}}</ref>

[[Efgartigimod alfa/hyaluronidase]] (Vyvgart Hytrulo) was approved for medical use in the United States in June 2023.<ref>{{Cite press release |title=Halozyme Announces argenx Receives FDA Approval for Vyvgart Hytrulo With Enhanze for Subcutaneous Use in Generalized Myasthenia Gravis |date=20 June 2023 |publisher=Halozyme Therapeutics |url=https://www.prnewswire.com/news-releases/halozyme-announces-argenx-receives-fda-approval-for-vyvgart-hytrulo-with-enhanze-for-subcutaneous-use-in-generalized-myasthenia-gravis-301855994.html |via=PR Newswire |access-date=24 June 2023 |url-status=live |archive-url=https://web.archive.org/web/20230624173634/https://www.prnewswire.com/news-releases/halozyme-announces-argenx-receives-fda-approval-for-vyvgart-hytrulo-with-enhanze-for-subcutaneous-use-in-generalized-myasthenia-gravis-301855994.html |archive-date=24 June 2023}}</ref><ref>{{Cite press release |title=Argenx Announces U.S. Food and Drug Administration Approval of Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc) Injection for Subcutaneous Use in Generalized Myasthenia Gravis |date=20 June 2023 |url=https://www.argenx.com/news/argenx-announces-us-food-and-drug-administration-approval-vyvgart-hytrulo-efgartigimod-alfa |access-date=24 June 2023 |url-status=live |archive-url=https://web.archive.org/web/20230624190259/https://www.argenx.com/news/argenx-announces-us-food-and-drug-administration-approval-vyvgart-hytrulo-efgartigimod-alfa |archive-date=24 June 2023 |website=Argenx}}</ref>

[[Rozanolixizumab]] (Rystiggo) was approved for medical use in the United States in June 2023.<ref>{{Cite web |date=28 June 2023 |title=Novel Drug Approvals for 2023 |url=https://www.fda.gov/drugs/new-drugs-fda-cders-new-molecular-entities-and-new-therapeutic-biological-products/novel-drug-approvals-2023 |url-status=live |archive-url=https://web.archive.org/web/20230121035617/https://www.fda.gov/drugs/new-drugs-fda-cders-new-molecular-entities-and-new-therapeutic-biological-products/novel-drug-approvals-2023 |archive-date=21 January 2023 |access-date=28 June 2023 |website=U.S. [[Food and Drug Administration]] (FDA)}}</ref><ref>{{Cite press release |title=UCB announces U.S. FDA approval of Rystiggo (rozanolixizumab-noli) for the treatment of adults with generalized myasthenia gravis |date=27 June 2023 |publisher=UCB |url=https://www.prnewswire.com/news-releases/ucb-announces-us-fda-approval-of-rystiggo-rozanolixizumab-noli-for-the-treatment-of-adults-with-generalized-myasthenia-gravis-301864023.html |via=PR Newswire |access-date=28 June 2023 |url-status=live |archive-url=https://web.archive.org/web/20230628045311/https://www.prnewswire.com/news-releases/ucb-announces-us-fda-approval-of-rystiggo-rozanolixizumab-noli-for-the-treatment-of-adults-with-generalized-myasthenia-gravis-301864023.html |archive-date=28 June 2023}}</ref>

====Acetylcholinesterase inhibitors====
Acetylcholinesterase inhibitors can provide symptomatic benefit and may not fully remove a person's weakness from MG.<ref name="Mehndiratta_2014">{{Cite journal |vauthors=Mehndiratta MM, Pandey S, Kuntzer T |date=October 2014 |title=Acetylcholinesterase inhibitor treatment for myasthenia gravis |journal=The Cochrane Database of Systematic Reviews |volume=2014 |issue=10 |pages=CD006986 |doi=10.1002/14651858.CD006986.pub3 |pmc=7390275 |pmid=25310725}}</ref> While they might not fully remove all symptoms of MG, they still may allow a person the ability to perform normal daily activities.<ref name="Mehndiratta_2014" /> Usually, acetylcholinesterase inhibitors are started at a low dose and increased until the desired result is achieved. If taken 30 minutes before a meal, symptoms will be mild during eating, which is helpful for those who have difficulty swallowing due to their illness. Another medication used for MG, [[atropine]], can reduce the muscarinic side effects of acetylcholinesterase inhibitors.<ref>{{Cite web |date=2014 |title=Atropine – Myasthenia-gravis medicines and drugs |url=http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Myasthenia-gravis&medicine=Atropine |archive-url=https://web.archive.org/web/20150712212657/http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Myasthenia-gravis&medicine=Atropine |archive-date=12 July 2015 |access-date=2015-07-11 |publisher=NHS Choices}}</ref> [[Pyridostigmine]] is a relatively long-acting drug (when compared to other cholinergic agonists), with a half-life around four hours with relatively few side effects.<ref name=":1">{{Cite journal |vauthors=Kumar V, Kaminski HJ |date=February 2011 |title=Treatment of myasthenia gravis |journal=Current Neurology and Neuroscience Reports |volume=11 |issue=1 |pages=89–96 |doi=10.1007/s11910-010-0151-1 |pmid=20927659 |s2cid=41052495}}</ref> Generally, it is discontinued in those who are being mechanically ventilated, as it is known to increase the amount of salivary secretions.<ref name=":1" /> A few high-quality studies have directly compared cholinesterase inhibitors with other treatments (or placebo); their practical benefit may be so significant that conducting studies in which they would be withheld from some people would be difficult.<ref name="auto" />

====Immune suppressants====
The steroid [[prednisone]] might also be used to achieve a better result, but it can lead to the worsening of symptoms and takes weeks to achieve its maximal effectiveness.<ref name=":1" /> Research suggests that up to 15% of patients do not positively respond to immune suppressants.<ref>{{Cite journal |vauthors=Drachman DB, Adams RN, Hu R, Jones RJ, Brodsky RA |date=2008-06-01 |title=Rebooting the immune system with high-dose cyclophosphamide for treatment of refractory myasthenia gravis |journal=Annals of the New York Academy of Sciences |volume=1132 |issue=1 |pages=305–314 |bibcode=2008NYASA1132..305D |doi=10.1196/annals.1405.033 |pmc=3390145 |pmid=18567882}}</ref><ref>{{Cite journal |vauthors=Suh J, Goldstein JM, Nowak RJ |date=June 2013 |title=Clinical characteristics of refractory myasthenia gravis patients |journal=The Yale Journal of Biology and Medicine |volume=86 |issue=2 |pages=255–260 |pmc=3670444 |pmid=23766745}}</ref><ref name="auto1" /> Due to the myriad symptoms that steroid treatments can cause, it is not the preferred method of treatment.<ref name=":1" /> Other immune suppressing medications may also be used including [[rituximab]]<ref>{{Cite journal |vauthors=Tandan R, Hehir MK, Waheed W, Howard DB |date=August 2017 |title=Rituximab treatment of myasthenia gravis: A systematic review |journal=Muscle & Nerve |volume=56 |issue=2 |pages=185–196 |doi=10.1002/mus.25597 |pmid=28164324 |s2cid=19504332}}</ref> or [[azathioprine]].<ref name="NIH2016" />

[[Nipocalimab]] (Imaavy) was approved for medical use in the United States in April 2025.<ref>{{cite web | title=Novel Drug Approvals for 2025 | website=U.S. [[Food and Drug Administration]] (FDA) | date=1 May 2025 | url=https://www.fda.gov/drugs/novel-drug-approvals-fda/novel-drug-approvals-2025 | access-date=1 May 2025}}</ref><ref name="JandJ PR 20250430">{{cite press release | title=Johnson & Johnson receives FDA approval for Imaavy (nipocalimab-aahu), a new FcRn blocker offering long-lasting disease control in the broadest population of people living with generalized myasthenia gravis (gMG) | publisher=Johnson & Johnson | via=MultiVu | date=30 April 2025 | url=https://www.multivu.com/johnson-johnson/9331651-en-johnson-johnson-receives-fda-approval-imaavy-nipocalimab-aahu | access-date=1 May 2025}}</ref>