Christyn Edmundson, MD, is a neurology and neuromuscular medicine specialist with the Providence Swedish Neuroscience Institute in Seattle.
Myasthenia gravis (MG) is a neuromuscular condition that can cause weakness in any of the muscles that you control. That's because the disease affects the signals between nerves and muscles. MG happens when your immune system goes haywire, making proteins called antibodies that attack healthy cells or tissues by mistake.
Fortunately, more treatments than ever are available to boost your strength, help keep your symptoms in check, and possibly improve your quality of life. We talked with Christyn Edmundson, MD, about why newer treatments have been game changers and what to know about recently approved medications.
Q: How has the outlook for people with myasthenia gravis changed due to advances in treatment?
Edmundson: Over the last decade, the range of treatments that are available to treat people with myasthenia gravis has really expanded. The menu of options is much longer than it used to be.
For the average patient, you had steroids and you had non-steroidal immunosuppressants and you had rescue therapies for flares. And that was kind of it. And then starting around 2017 or so, we've really seen this big expansion in both the number of drugs and in the types of drugs. These new drugs work in different ways than the older ones did. They're more-targeted, meaning instead of really broadly affecting the immune system, they're targeted at very specific parts of the immune system.
So this new range of tools that we have to treat people with myasthenia gravis is great for all different kinds of patients, like people who are newly diagnosed or for whom some of the traditional therapies might not be appropriate; maybe because of certain medical conditions they have or side effects of the traditional medications, they're not great candidates for them. And similarly for patients maybe who have tried a lot of therapies who aren't getting the benefit, who are still having a lot of symptoms, who are still having a lot of flares, who are still having hospitalizations — now we have a lot more tools that we can use to try and bring their disease under control.
Q: In 2025, the FDA approved two new medications for MG: inebilizumab (Uplizna) and nipocalimab (Imaavy). What should people know about these drugs?
Edmundson: Both of these drugs are approved for patients with generalized myasthenia gravis, which means they have symptoms that affect muscles beyond the eyes. Most people with generalized myasthenia gravis also have eye symptoms, but anything outside of the eyes gives you generalized MG. Uplizna is for adults 18 and over, whereas Imaavy is approved for people ages 12 and older.
More specifically, both drugs are approved for people with generalized myasthenia gravis who are seropositive for either ACHR (acetylcholine receptor) or MuSK (muscle-specific tyrosine kinase) antibodies. Serostatus is another way that we categorize myasthenia gravis: what antibodies are in the blood that we think cause myasthenia.
The vast majority of people with generalized myasthenia gravis have ACHR antibodies — about 85%. And then a smaller percentage of patients have MuSK. (A small, even tinier proportion of patients have antibodies against a protein called LRP4, and then a small percentage of patients don't have any antibody that you can detect.)
Q: How effective were the two drugs in clinical trials?
Edmundson: Each of these drugs was studied in what's called a randomized placebo-controlled trial. And each trial showed that the patients who received the drug, whether it was Imaavy or Uplizna, had improvement in their myasthenia symptoms compared with patients who received placebo. So the top-line result is that both of these drugs appear to show effect.
Now, that doesn't mean that everybody shows a response to them. In both trials, there were some people whose MG responded really dramatically and those people had a huge benefit. And there were some people who had moderate benefit. And there were some people who had no benefit, even those who got the drug. But if you average how everybody did, the patients in the drug-receiving groups did better.
In both trials, the key outcome is a score called the MGADL score, or the Myasthenia Gravis Activities of Daily Living score, which is a disease-severity score that sort of rates how bad someone's symptoms are in multiple domains. Low scores mean less disease symptoms, high scores mean bad disease symptoms over the preceding seven days. So that's kind of the key outcome: that people who were on the drug in each trial had lower MGADL scores.
Q: What are some barriers that could prevent patients from trying newer medications like these?
Edmundson: I think that honestly, one of the biggest barriers is just awareness and access to care. As there are more and more of these drugs, it's really hard for doctors to keep abreast of what's available and how they work and how they're dosed if you're not seeing a lot of patients with myasthenia.
It can be really helpful for patients to see a neurologist, whether it's a general neurologist or someone who is a neuromuscular specialist, which is the type of doctor who sees myasthenia gravis often; so, someone who has experience with myasthenia gravis and is aware of these newer drugs.
And that goes along with patient awareness. I'll see this happen not infrequently, where someone has had myasthenia for a long time and maybe they're on some prednisone and they're on one of those traditional older nonsteroidal drugs. For some people, they do great. They have no symptoms at all. Fantastic. They don't need a new drug. But for some people, they have a bunch of lingering symptoms and a bunch of side effects from their current medication regimen. And those are people who might benefit from considering one of these newer agents to see if maybe they can get either better disease control or fewer side effects with one of the new drugs.
Q: What can you do if your health insurance plan won't cover a newer drug?
Edmundson: I think that a couple of things can be helpful. One is getting the help of your doctor. There are different avenues in which you can appeal medication denial. So there's like an authorization process where you have to get authorization to get the medicine covered. If the insurance company says no, your doctor can write letters or ask for appeals. And then usually with most insurance companies, you can get something called a peer to peer, which is where the doctor actually talks to an insurance company doctor.
There are times when an insurance company doesn't even let you do a peer to peer. It depends on the insurance. And with Medicare, if your disease falls outside what a drug is indicated for, it can be really hard to get coverage.
The other thing that can be helpful is that a lot of the companies that make these drugs have assistance programs, and that can include assistance to your doctor for appeals. They actually have literature and information about why a drug should be covered that can save your doctor some time in terms of arguing with the insurance company process. And then some of the companies actually also have programs that if your insurance doesn't cover the drug, they can help you get the drug at a significantly reduced cost.
So I would say, work with your doctor, who can also see what programs the companies that actually make the drugs have. That could potentially help get access to some of the newer agents.
