Table 1

New and emerging treatments for myasthenia gravis by therapeutic class

Class	Mechanism of action	Drug name	Route	Recommendations	Studies*
B cell depletion	Target CD20, lead to B cell depletion	Rituximab: chimeric monoclonal antibody	Intravenous	Early consideration in MuSK+MG, third line for AChR+gMG	Blinded prospective study for MuSK+MG and retrospective studies. Phase 2 BeatMG trial
B cell depletion	Target CD19, lead to B cell depletion	Inebilizumab: humanised monoclonal antibody	Intravenous	TBD	Phase 3 randomised controlled trial of AChR+gMG and MuSK+MG ongoing
Complement inhibition	Block cleavage of C5 into C5a and C5b and prevent formation of membrane attack complex	Eculizumab: humanised monoclonal antibody	Intravenous	Refractory AChR+gMG	Phase 3 REGAIN trial completed. FDA approval for AChR+gMG in 2017
		Ravulizumab: humanised monoclonal antibody	Intravenous	AChR+gMG	Phase 3 CHAMPION study completed. FDA approval for AChR+gMG in 2022
		Zilucoplan: 15 amino acid peptide	Subcutaneous	TBD	Phase 3 RAISE trial AChR+gMG completed, and primary and key secondary endpoints met
Neonatal Fc receptor inhibition	Bind and block neonatal Fc receptor, reduce IgG recycling and level of IgG antibodies	Efgartigimod alfa: Fc fragment of human IgG1	Intravenous	AChR+gMG	ADAPT trial completed. FDA approval for AChR+gMG in 2021
		Rozanolixizumab: humanised IgG4	Subcutaneous	AChR+MG and MuSK+MG are enrolled	Phase 3 MycarinG study completed, and primary and key secondary endpoints met
		Batoclimab: humanised IgG1	Subcutaneous	TBD	Phase 3 randomised controlled trial of generalised myasthenia gravis ongoing
		Nipocalimab: humanised IgG1	Intravenous	TBD	Phase 3 randomised controlled trial of generalised myasthenia gravis ongoing
Interleukin 6 inhibition	Block interleukin 6 receptor, reduce proinflammatory T cell and B cell differentiation	Satralizumab: humanised IgG2	Subcutaneous	TBD	Phase 3 randomised controlled trial of AChR+gMG ongoing
Chimeric antigen receptor T cell treatment	Modify T cells and their regulation of B cell maturation	Descartes-08	Subcutaneous	TBD	Phase 1/2 trial ongoing

FDA=US Food and Drug Administration; AChR+MG=acetylcholine receptor antibody positive myasthenia gravis; AChR+gMG=acetylcholine receptor antibody positive generalised myasthenia gravis; MuSK+MG=muscle specific tyrosine kinase antibody positive myasthenia gravis; TBD=to be determined.
*Study names: BeatMG=B Cell Targeted Treatment in Myasthenia Gravis; REGAIN=Safety and Efficacy of Eculizumab in Refractory Generalised Myasthenia Gravis; CHAMPION=Safety and Efficacy Study of Ravulizumab in Adults With Generalised Myasthenia Gravis; RAISE=Safety, Tolerability, and Efficacy of Zilucoplan in Subjects With Generalised Myasthenia Gravis; ADAPT=An Efficacy and Safety Study of ARGX-113 in Patients With Myasthenia Gravis Who Have Generalised Muscle Weakness: MycarinG=A Study to Evaluate Rozanolixizumab in Study Participants With Generalised Myasthenia Gravis.