For people with myasthenia gravis (MG) and the doctors who care for them, the good news keeps coming. On April 30, 2025, the U.S. Food and Drug Administration (FDA) approved nipocalimab-aahu (Imaavy) to treat generalized MG. Imaavy is the seventh drug—including the subcutaneous formulation of Vyvgart—that the FDA has approved in the last 90 months; on average, about one new drug for MG has been approved annually since 2018. With multiple other treatments in varying stages of clinical development, including several different CAR-T therapies, patients can expect more options in the years to come.
While this news is undeniably welcome, the pace of therapeutic development poses challenges. Which treatment is best for an individual patient? How can we ensure that everyone eligible for these treatments can access them? What options exist for patients who do not respond to a treatment or are not eligible for them? And lastly, how can society afford to pay for these expensive treatments?
This special issue of Brain & Life provides guidance on these questions and more with the aim of empowering patients to engage with their neurologists and to also prepare to advocate for themselves and others with MG. Our feature story provides a detailed look at the new MG treatments, including topics patients can discuss with their neurologist to help pick the best medication for them. Key topics to discuss include treatment eligibility, potential side effects, the frequency and method of treatment, where you receive treatment (at home vs. in the doctor's office), and more.
Not everyone is eligible for these new options. Most have been approved only for people with generalized MG who have antibodies that bind to a protein called the acetylcholine receptor. Two treatments also were approved for patients with antibodies to muscle-specific tyrosine kinase (MuSK), a signaling molecule. (Patients who do not have one of these antibodies are known as “seronegative MG.”) People with ocular MG are ineligible for the new treatments.
Most, but not all, patients who try these treatments will respond to them, and those who do may not have a complete resolution of their symptoms. For these patients, it may help to identify other treatment approaches. Regardless of what treatment works for them, though, they may find some relief in exercise. In the story, “Stay Fit with Group Exercise Classes,” we share information on the benefits of working out with others when you have MG (or other neurologic disorders) and how best to access an appropriate program.
The past few years have been transformational for the MG community, yet many challenges remain. There is an urgent need to develop therapies for patients ineligible for currently available drugs. Many patients have difficulty affording their medications, and others experience barriers to insurance coverage for their treatment. Patients with limited financial means and lack of easy access to neurologists with MG expertise are particularly impacted. People with MG can play an essential role in overcoming these challenges, however, by becoming advocates. Advocacy can take the form of connecting with other patients or engaging with legislators or policy makers. Our article provides examples of and a roadmap for engagement and empowerment.
Each article in this issue addresses ways in which patients with MG can be empowered. I hope this information will further enhance the partnership between people with MG and their neurologists in our shared goal of providing the highest quality care for everyone with this condition.
Gordon Smith, MD, FAAN, Issue Editor
