For information about active and currently recruiting MG Clinical Trials, visit the MGFA CLINICAL TRIALS webpage.
MGFA & American Brain Foundation Partnering on New Clinical Research Award for MG
July 1, 2021
MGFA is partnering with the American Brain Foundation on a clinical research award for myasthenia gravis. The application opens on July 1 and runs through October 1. Here is the link with details: https://www.aan.com/education-and-research/research/aan-research-program/clinician-scientist-development-award-in-myasthenia-gravis/
This award aims to recognize the importance of good clinical research and to encourage young investigators in clinical studies related to myasthenia gravis. It will consist of a commitment of $75,000 per year for three years, plus a $5,000 per year stipend to support education and research-related costs for a total of $240,000. Supplementation of the award with other grants is permissible, but to be eligible to apply for this award, the other grant source(s) cannot exceed $80,000 annually. Please only submit one application - applicants are not allowed to submit applications for more than one award. Your application will also be considered for all relevant clinician-scientist development awards.
October 1, 2021: Application deadline: Note that this is the deadline for all documents, including those from the mentor and chair. Applications will be declined if this information is not submitted by October 1.
January 2022: Notification of recipients
July 1, 2022: Funding begins
COVID-19 Associated Risks and Effects in Myasthenia Gravis (CARE-MG)
CARE-MG, a physician-reported registry, is a joint effort of the International MG/COVID-19 Working Group and neurologists from across the globe to capture outcomes of people with MG who have developed COVID-19 infections formally launched on 09 April 2020.
Robust international participation and collaboration is critical to our collective success in answering fundamental questions: Do MG patients face special risks? Do baseline therapies impact risk? Together, the two groups along with several independent experts have designed and launched this international registry. Click here to learn about the current CARE-MG Research Policy.
We hope to capture outcomes in all types of myasthenia gravis (AChR, MuSK, LRP4, Seronegative) irrespective of current treatment status who have confirmed of suspected COVID-19 infection.
- Laboratory Confirmed COVID-19 - Positive viral RNA tests or positive serology for SARS-CoV-2
- Suspected COVID-19 but not confirmed - Fever with Dry cough, +/- anorexia, myalgias, dyspnea, anosmia/ageusia, potential exposure, Chest imaging suggestive of COVID
- Myasthenia Gravis: As defined by treating physician based on antibody status and if seronegative (based on standard testing such as repetitive testing, single fiber EMG, response to acetylcholine esterase inhibitors)
To Learn More about CARE-MG, visit the following webpage:
Please See the Current CARE-MG Policy.
NeuroSeries Online Event Focused on MG Diagnostics and Treatments Webinar
Current management options for generalized myasthenia gravis (gMG) often leave patients with uncontrolled symptoms and frequent myasthenic crises. Recent improvements in the understanding of the complex pathophysiology of gMG, including the pivotal role of IgG autoantibodies, have led to new antibody tests to improve diagnoses. In addition, targeted treatment options may help address the need for a more rapid onset of effect while improving efficacy.
Join moderator James Howard Jr., MD and esteemed speaker Nicholas Silvestri, MD, FAAN as they discuss emerging biomarkers and autoantibody tests to improve diagnosis, provide patient-centered management, and enhance patient- and physician-reported outcomes. Webinar replay from Tuesday, March 9, 2021 VIEW THE REPLAY HERE.
This NeuroSeries event is provided by PlatformQ Health Education, LLC working in collaboration with the Myasthenia Gravis Foundation of America (MGFA), National Organization for Rare Disorders (NORD), and the Muscular Dystrophy Association (MDA).
MGFA Partner argenx Offers Two Year MG Study called MyRealWorld MG
MyRealWorld MG is an international two-year study assessing the impact of Myasthenia Gravis on patients’ lives. Be part of this meaningful argenx-sponsored research study to better understand the lives of people living with MG. Working with patient organizations from 9 countries (US, Japan, Germany, UK, France, Italy, Spain, Canada, Belgium), biotechnology company argenx sponsors this innovative study and is inviting MG patients from around the world to participate and share information. You can download and use the MyRealWorld mobile app to enter data. READ MORE about this study HERE.
Submissions Requested: High-Impact Pilot Projects on Myasthenia Gravis and Related Neuromuscular Junction Disorders:
We request submission of proposals to support pilot studies that are highly focused and innovative, with a clear plan that will lead to new federal, pharmaceutical or private foundation supported investigations.
REMINDER: Letters of Intent (LOI) for the 2021 funding opportunity are due on March 25, 2021. CLICK HERE to DOWNLOAD the LOI guidelines form. If you have been invited to submit a proposal, full proposals are due by June 22, 2021. For 2021 Research Funding announcement details and all Required Submission Paperwork, PLEASE CLICK HERE.
MGFA Proudly Announces its Research Pilot Grant Recipients for 2020:
Congratulations to these deserving scientific researchers for their work to find better treatments for myasthenia.
Identification of biomarkers that leverage mechanisms of autoantibody pathology in AChR MG ($55,000 - One Year Award)
Dr. Kevin O’Connor
MG is characterized by the presence of acetylcholine receptor antibodies in the blood, which cause the disease by different mechanisms which are not fully understood. We are developing a group of assays that classify and quantify these antibody types to predict treatment response, monitor disease progression, and enable personalized therapeutic decisions that avoid severe side effects.
Measuring adverse event burden in myasthenia gravis: Validation on adverse event unit ($55,000 - One Year Award)
Dr. Michael Hehir
University of Vermont
There is increasing emphasis on long term side effect burdens for patients with MG as we attempt to understand differences between treatments. Understanding the side effect burden is paramount when designing unique treatment strategies. We have created a patient and physician consensus unit (akin to currency such as the US Dollar) called the Adverse Event Unit (AEU) to better measure this burden. The goal of the project is to evaluate the validity, utility, and feasibility of using the AEU as a measure of MG treatment burden.
Defining the clinical phenotype and immunopathology of seronegative MG ($150,000 - 2 Year Award)
Dr. Jeffrey Guptill - Duke University
Dr. Kevin O’Connor – Yale University
Seronegative MG (SNMG) is a disease subset of MG defined by the absence of detectable autoantibodies that are otherwise present in a majority of patients. Little is known about SNMG and it has not been well-studied. Two major goals of this project include: 1) to better understand the characteristics of SNMG patients, and 2) to better understand the abnormal immune system functions that contribute to this disease subset. This work will define the features that will lead to better treatment guidance in the future.
Circulating Th1/17 cells a biomarker of disease severity and target for early intervention for MG patients.
Dr. Jeff Guptill and research staff at the Duke Early Phase Clinical Research Unit at Duke University Medical Center has submitted another new paper that has been accepted by the Journal of Neuroimmunology. The research was the result of a transformative grant provided by the Myasthenia Gravis Foundation of America.
This study focuses on a group of patients with myasthenia gravis (MG) who have anti‐muscle‐specific kinase antibodies (MuSK-MG). Patients with MuSK-MG tend to respond well to therapies that lower anti-MuSK antibodies. Follicular helper T (Tfh) cells are a type of immune cell (a subset of T-cells) that help another type of immune cell, called B cells, produce antibodies.
Tfh cells are not well-studied in MuSK-MG patients. In this study, we found that T cells in MuSK-MG promote inflammation. In addition, a subset of Tfh cells, called Tfh17 cells, are higher among patients with MuSK-MG than healthy people without MuSK-MG. These Tfh17 cells are in part responsible for the inflammatory response in MuSK-MG and may help B cells produce more antibodies.
In summary, these results support a role for Tfh cell dysfunction in MuSK-MG. Highly specific treatment strategies to rebalance Tfh cells are a potential target for treating patients with MuSK-MG in the future.
Click here to read the article or click here to read the full report.
Momenta announced positive topline results from their interim analysis of the Vivacity-MG study investigating nipocalimab in patients with #MyastheniaGravis (MG). Read more about the results here.
Key highlights from the presentation we made this morning:
- 52% of patients who received nipocalimab had rapid, significant and durable reductions in MG-ADL scores (at least a 2-point reduction from baseline for at least 4 consecutive weeks) across all doses, versus 15% of placebo treated patients.
- A statistically significant relationship was observed between autoantibody (IgG) reduction and clinical benefit for patients taking nipocalimab (p<0.0001).
- Patients across all four nipocalimab dosing arms showed rapid reductions in MG-ADL scores, with clinically meaningful changes in scores within two weeks. Anti-MuSK patients were also included in the study and had similar responses.
- Nipocalimab was well tolerated, safe and efficacious in gMG patients. There were no severe or serious nipocalimab-related adverse events and most adverse events were characterized as mild.
- The study findings support continued clinical development in gMG and subcutaneous formulation dose selection.
Cavalcante P, Serafini B, Mantegazza R. et al. Epstein-Barr virus persistence and reactivation in myasthenia gravis thymus. Ann Neurol 2010;67:726–738.
Investigators report evidence of the Epstein-Barr virus (EBV) in the thymus of six patients with myasthenia gravis. None of the controls had EBV. The Epstein-Barr virus is active in the thymus of myasthenia gravis patients, according to a new study in a small number of patients. If confirmed, this discovery could help explain the cause of the disease and, at least in theory, suggest new treatments.
To read the full article, click here.
How is the novel coronavirus pandemic impacting people with rare diseases and their families? Complete the 20-minute research survey from home or learn more at this link.
The Rare Diseases Clinical Research Network (RDCRN) is conducting this study. The network is funded by the National Institutes of Health. It includes 23 research teams working to advance diagnosis and treatment of groups of rare diseases. The Myasthenia Gravis Foundation of America and Conquer MG partners with RDCRN through its work with the Myasthenia Gravis Rare Disease Network (MGNet).
March 23, 2020
International MG/COVID Working Group*
International MG/COVID-19 Working Group1SaijuJacoba2SrikanthMuppidib2AmandaGuidoncJeffreyGuptilldMichaelHehireJames F.HowardJrfIsabelIllagRenatoMantegazzahHiroyukiMuraiiKimiakiUtsugisawajJohnVissingkHeinzWiendllRichard J.Nowakm2
Corona Virus Disease 2019 (COVID-19) is a new illness caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Symptoms are variable but typically include fever, cough, respiratory symptoms, diarrhea, reduction of smell and taste sensation. Severity ranges from mild to severe and the virus may lead to pneumonia, acute respiratory distress syndrome and death, in some patients. Nearly every country in the world has been affected by this virus and is currently defined as a pandemic, by the World Health Organization. There are no known proven therapies for treating this virus and no vaccine to prevent the infection at this time.
The full guidance is available here.
Many patients with generalized myasthenia gravis (gMG) have substantial clinical disability, persistent disease burden, and adverse effects attributable to chronic immunosuppression. Therefore, there is a significant need for targeted, well-tolerated therapies with the potential to improve disease control and enhance quality of life.
The findings of the above-mentioned study, published by JAMA Neurology, support a potential therapeutic role for zilucoplan in generalized myasthenia gravis and further evaluation in a phase 3 study.
MGFA announces 2020 Research Funding Opportunities- Deadline Extended to 5/23/2020!
We are pleased to announce the release of our Request for Applications for our High Impact Clinical Research and Scientific Pilot Projects on Myasthenia Gravis and Related Neuromuscular Junction Disorders.
We are also very pleased to announce our first targeted research opportunity to benefit the Seronegative MG community.
To learn about our research agenda and complete funding opportunities, see here.
For families with children that have myasthenia gravis, we have some exciting news to share. Thanks to a generous gift from an anonymous donor to the University of California, San Francisco, the first clinical Pediatric Myasthenia Gravis Consortium is now a reality. MGFA was honored to provide a grant to underwrite the costs for the September inaugural meeting of this exciting new project, and to participate on the advisory committee for the Consortium.
In children, myasthenia gravis (MG) almost always appears in one of two forms: ocular myasthenia gravis (OMG), where weakness is evident only in the eyelids and surrounding tissue, whereas in generalized myasthenia gravis (GMG), various tissues throughout the body are affected. This study, published in Muscle & Nerve, examines how these two disease types tend to differ from a clinical perspective, as well as patient response to treatment.
The National Institutes of Health (NIH) has awarded a research team at the George Washington University (GW) $7.8 million to establish a rare disease network for myasthenia gravis. The network, which will be part of 25 established NIH Rare Diseases Clinical Research Networks, will include basic and clinical investigators, patient advocacy groups and biotechnology and pharmaceutical companies working together to enhance therapeutic development for this rare disease. The team is led by former and current MGFA Medical and Scientific Advisory (MSAB) Chairs, Henry Kaminski, MD and Linda Kusner, PhD, and the steering committee members are all leaders of the MGFA MSAB as well.
The grant will fund research into the underlying pathophysiology of the disease, provide fellowships in MG for young investigators, and fund pilot grants. This funding will also ensure that the serum bank created by the MGFA’s transformative grant will continue.
MGFA is proud to represent the MG Community as a member of MG Net, and has committed $250,000 of funding ($50,000 for each year) to support the project. This commitment from MGFA, as well as that of Illinois-based Conquer MG, was instrumental in demonstrating the support of the MG Community for the project—an essential component of the criteria for funding established by the NIH. Press release available here.
The study, "Metformin attenuates autoimmune disease of the neuromotor system in animal models of myasthenia gravis", published by International Immunopharmacology, used a mouse model to investigate the therapeutic potential of metformin on autoimmune myasthenia gravis. Researchers showed that oral administration of metformin diminished the onset, reduced clinical severity and led to a reduction in mortality in experimental autoimmune myasthenia gravis rats.
Ra Pharmaceuticals announced that the U.S. Food and Drug Administration (FDA) granted Orphan Drug Designation to zilucoplan for the treatment of myasthenia gravis. Ra Pharma is developing zilucoplan, a self-administered macrocyclic peptide inhibitor of complement component 5 (C5), for the treatment of generalized myasthenia gravis (gMG) and other rare, tissue-based complement-mediated diseases.
"Beyond the antibodies: serum metabolimic profiling of myasthenia gravis", published by Metabolomics, uses a profiling approach as a potential strategy for identifying biomarkers unique to myasthenia gravis. Comparisons between patients with MG vs. HC (healthy controls), and RA (rheumatoid arthritis) vs. HC were made using univariate and multivariate statistics.
"Heterogeneity and shifts in distribution of muscle weakness in myasthenia gravis", published by Neuromuscular Disorders, analyzes the distribution of muscle weakness in 225 AChR MG patients over time. The study identified phenotypes: ocular, bulbar, neck/ limbs/ respiratory, or a combination. MG patients frequently shift between phenotypes. These variations found in AChR MG suggest that other factors aside from the ACHR antibody mediated immune response are important in determining the disease expression of MG.
Patients who initially showed greater fluctuations in the electric signal at the neuromuscular junction and lower electrical signals (reduced by 20% or more) were more frequently positive for autoantibodies and had generalized disease. These patients were also classified as having more severe disease, having higher quantitative (above 10.5) myasthenia gravis score (QMGS) at baseline, compared to patients with better electrophysiological test results. See here for the full article from the Canadian Journal of Neurological Sciences, "Baseline Decrement in Patients with Mild Myasthenia Gravis Predicts Immunomodulation Treatment".
Several states have legalized the use of marijuana for medical and/or recreational use. Can marijuana or chemicals extracted or based upon components of marijuana help people with MG? Let’s consider what is currently known about medical benefits of marijuana. In researching this topic, members of the MGFA Medical and Scientific Advisory Board (MSAB), reviewed the scientific literature and the information available from reputable sources such as the National Institutes of Health, the American Academy of Neurology, the American Neurological Association and the American Medical Association. For more detail and our full statement, see here
The study, "Nocebo effect in myasthenia gravis: systematic review and meta-analysis of placebo-controlled clinical trials", published in the journal Acta Neurologia Belgica, is a meta-analysis of adverse events experienced by patients with myasthenia gravis following placebo treatment. The study demonstrates a low nocebo dropout rate in MG comapted to central nervous system disorders.
While many MG patients were affected by fatigue, sleepiness, depression and anxiety, the study, "Impact of autoimmune comorbidity on fatigue, slepiness and mood in myasthenia gravis", does not suggest that coexisting autoimmune diseases substantially contribute to the magnitude of these cumbersome comorbid symptoms. However, the higher frequency of steroid treatment may have counterbalanced the effects of the autoimmune comorbidity.
Results of the Phase 2 study were presented at the 2019 American Academy of Neurology Annual Meeting in May:
A group of scientists in Austria conducted a study to determine the efficacy of rituximab in treating myasthenia gravis. The study, titled, “High efficacy of rituximab for myasthenia gravis: a comprehensive nationwide study in Austria” looked at 56 patients and studied their response to rituximab, finding that 26.4% of the patients studied were in remission after three months of treatment. In this retrospective study on RTX for MG, the largest to date, RTX appeared safe, efficacious and fast acting. Benefit from RTX was greatest in MuSK ab + MG.