Acetylcholinesterase inhibitorThe original first-line therapy for MG — increases the amount of acetylcholine available at the neuromuscular junction. Fast acting, but treats symptoms rather than the underlying immune attack.
Mestinonpyridostigmine bromide
AChE inhibitor
Not antibody-specific
Oral tablet, extended-release tablet, or liquid
Multiple times per day (fast-acting); 1–2x/day for extended-release
Mestinon
Generic name
pyridostigmine bromide
Antibody criteria
Not antibody-specific
Delivery method
Oral tablet, extended-release tablet, or liquid
Frequency
Multiple times per day (fast-acting); 1–2x/day for extended-release
Dosage
Individualized and titrated to effect; commonly 60 mg tablets every 3–8 hours, or 180 mg extended-release once or twice daily, at least 6 hours apart.
Common side effects
Stomach cramps, diarrhea, nausea, increased saliva and sweating.
Serious side effects
Cholinergic crisis from too much medicine can cause worsening weakness and breathing trouble — it can look like a myasthenic crisis, so any new weakness needs prompt medical attention.
FDA status
FDA-approved for MG
Manufacturer
Bausch Health (brand); generic pyridostigmine widely available
Assistance program
Ask your pharmacist about generic discount programs; no dedicated manufacturer program
Corticosteroids & non-steroidal immunosuppressantsBroadly dampen the immune system to reduce the antibodies attacking the neuromuscular junction. Usually the next step after acetylcholinesterase inhibitors.
Prednisoneprednisone
Corticosteroid / immunosuppressant
Not antibody-specific
Oral tablet
Daily, or every other day once symptoms are controlled
Prednisone
Generic name
prednisone
Antibody criteria
Not antibody-specific
Delivery method
Oral tablet
Frequency
Daily, or every other day once symptoms are controlled
Dosage
Individualized — usually started low and increased gradually until symptoms improve, then tapered to the lowest effective dose.
Neonatal Fc receptor (FcRn) blockersBlock the receptor that normally protects IgG antibodies from being broken down — clearing out the harmful antibodies faster.
IMAAVYnipocalimab-aahu
FcRn blocker
AChR+ · MuSK+
IV infusion (first dose ~30 min, then ~15 min)
Every 2 weeks, after the first infusion
IMAAVY
Generic name
nipocalimab-aahu
Antibody criteria
AChR+ · MuSK+
Delivery method
IV infusion (first dose ~30 min, then ~15 min)
Frequency
Every 2 weeks, after the first infusion
Dosage
Weight-based, supplied as 300 mg or 1,200 mg single-dose vials.
Common side effects
Common cold-type infections, headache, infusion-related reactions.
Serious side effects
Increased infection risk; vaccines may be less effective during treatment.
Complement (C5) inhibitorsBlock the complement cascade that damages the neuromuscular junction after antibodies attach. All carry a boxed warning for serious meningococcal infection and require REMS enrollment.
Soliriseculizumab
C5 inhibitor
AChR+
IV infusion (~35 minutes)
Weekly for the first 5 doses, then every 2 weeks
Soliris
Generic name
eculizumab
Antibody criteria
AChR+
Delivery method
IV infusion (~35 minutes)
Frequency
Weekly for the first 5 doses, then every 2 weeks
Dosage
900 mg weekly ×4, 1,200 mg at week 5, then 1,200 mg every 2 weeks.
Not daily or cyclical drug therapies, but part of the MG treatment landscape — used for emergencies, as a bridge, or as a one-time procedure.
IVIg (intravenous immunoglobulin)
Infusion · Emergency or maintenance
Donated, pooled antibodies given by IV. Used as a short-term emergency treatment (myasthenic crisis, before surgery) over 2–5 days, or as maintenance every 3–6 weeks. Common side effects include headache, chills, and flu-like symptoms; rare serious effects include kidney problems and blood clots.
Hizentra (subcutaneous immunoglobulin)
CSL Behring · Not yet FDA-approved for MG
A less-invasive way to receive immunoglobulins, given under the skin at up to 8 sites over 1–2 hours, often at home. Approved for other neurologic and immune conditions; use in MG is still investigational.
Therapeutic plasma exchange
Plasmapheresis · Emergency use
Filters the blood to remove antibody-containing plasma, replacing it with clean fluid, via a vein or port. Used short-term for emergencies or before surgery; repeated treatments are often needed since the body keeps producing antibodies.
Thymectomy
Surgery · One-time procedure
Surgical removal of the thymus gland. Strongly recommended if a thymoma is present, and often considered earlier in AChR+ generalized MG to improve long-term symptoms and reduce reliance on corticosteroids.
Samm brings more than two decades of nonprofit experience, serving in executive leadership roles for healthcare nonprofits such as March of Dimes, National Brain Tumor Society, and the American Liver Foundation. She has an extensive background in organizational management, strategic planning, board and volunteer development, and revenue generation that results in growth and impact. As MGFA’s senior executive, Samm is responsible for providing the vision and strategy to fulfill the work identified in the organization’s strategic plan, support the MGFA’s vision and mission, and ensure that both the operational and board structures support this work.
