Myasthenia gravis: State of the art and new therapeutic strategies

Myasthenia Gravis (MG) – an autoimmune neuromuscular disease – is known by the production of autoantibodies against components of the neuromuscular junction mainly to the acetylcholine receptor, which cause the destruction and compromises the synaptic transmission. This disease is characterized by fluctuating and fatigable muscle weakness, becoming more intensive with activity, but with an improvement under resting. There are many therapeutic strategies used to alleviate MG symptoms, either by improving the transmission of the nerve impulse or by ameliorating autoimmune reactions with e.g. steroids, immunosuppressant drugs, or monoclonal antibodies (rituximab and eculizumab). Many breakthroughs in the discovery of new therapeutic targets have been reported, but MG remains to be a chronic disease where the symptoms are kept in the majority of patients. In this review, we discuss the different therapeutic strategies that have been used over the years to alleviate MG symptoms, as well as innovative therapeutic approaches currently under study. [Display omitted] •Myasthenia Gravis is characterized by fluctuating and fatigable muscle weakness;•Disease becomes intensive with activity, but improves under resting.•Monoclonal antibodies are innovative therapeutic targets.•New therapeutic strategies are an alternative to patients that are refractory to classical medicines.