Learn The BasicsMyasthenia gravis (MG) can be treated with medications like cholinesterase inhibitors, corticosteroids, or immunosuppressants. It can also be treated with intravenous therapy or surgery.
The type of treatment for each patient is determined based on their age, medical history, preferences and the severity of the disease.
Medical treatment
The first-line treatment for MG is a medicine called pyridostigmine. This is a cholinesterase inhibitor or agent that blocks the action of the enzyme that clears acetylcholine. The aim of the treatment is to ensure more acetylcholine is available for longer to transmit signals from nerve cells to muscle fibers.
Another medical treatment often used to treat MG are corticosteroids like prednisone. Corticosteroids inhibit the action of the immune system, which in MG, produces antibodies that mistakenly attack the acetylcholine receptors (AChR) at the neuromuscular junction, the connection between nerve cells and muscle cells.
Dampening the immune system with corticosteroids may improve the symptoms of MG. However, their long-term use can cause serious side effects like bone thinning, weight gain and diabetes. Corticosteroid use also increases the risk of serious infections.
Finally, more specific immune suppressants may also be used to treat patients with MG, like azathioprine, mycophenolate mofetil, cyclosporine, methotrexate and tacrolimus. These also aim to dampen the immune system and reduce the immune attack against the AChRs. They usually take a few months to start working and may be used together with corticosteroids. The use of immunosuppressants also increases the risk of serious infections. They may also cause liver or kidney damage.
Intravenous therapy
Intravenous therapy is usually used to treat symptoms that suddenly become worse in patients with MG or before surgery or the initiation of other therapies. They can be in the form of plasmapheresis or plasma exchange, intravenous immunoglobulins or IVIG, or monoclonal antibodies.
Plasma exchange is a procedure in which the patient’s blood is filtered of antibodies, including the autoantibodies involved in MG. This is a temporary solution, as the body produces the harmful autoantibodies again within a few weeks. The procedure may also lead to complications like a drop in blood pressure, bleeding, problems with heart rhythm and muscle cramps.
In IVIG therapy, antibodies that alter the action of the immune system are given to the body in an attempt to reduce the symptoms of MG. Side effects of IVIG may include dizziness, chills, headaches and fluid retention.
Monoclonal antibodies like rituximab or eculizumab can also be given intravenously, but they are usually only given if no other treatment works, as they can have serious side effects.
Surgery
In some patients with MG, a surgical procedure called a thymectomy may be beneficial.
In this surgery, the thymus gland, in which specialized immune cells called T-cells are made, is removed, along with any thymic tumors that may be associated with the disease.
This approach may improve the symptoms of MG in some patients within a few months after the operation, and symptoms may continue to improve with time.
The procedure may be conducted as an open surgery or through keyhole surgery. Keyhole surgery may be video-assisted or robot-assisted.
Factors involved in the treatment choice include body mass index (BMI), the size of the thymus and prior surgery or disease treatment involving the chest.
Reviewed by Debjyoti Talukdar, M.D. on June 6, 2025.