Referral center for Neuromuscular disorders, Timone Hospital University, AIX-Marseille Université, Marseille, France; Filnemus, ERN NMD, Marseille, France.
Rev Neurol (Paris). 2024 Nov;180(9):971-981. doi: 10.1016/j.neurol.2024.09.006. Epub 2024 Oct 7.
Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disorder characterized by muscle weakness and fatigue. The disease is primarily caused by antibodies targeting acetylcholine receptors (AChR) and muscle-specific kinase (MuSK) proteins at the neuromuscular junction. Traditional treatments for MG, such as acetylcholinesterase inhibitors, corticosteroids, and immunosuppressants, have shown efficacy but are often associated with significant long-term side effects and variable patient response rates. Notably, approximately 15% of patients exhibit inadequate responses to these standard therapies. Recent advancements in molecular therapies, including monoclonal antibodies, B cell-depleting agents, complement inhibitors, Fc receptor antagonists, and chimeric antigen receptor (CAR) T cell-based therapies, have introduced promising alternatives for MG treatment. These novel therapeutic approaches offer potential improvements in targeting specific immune pathways involved in MG pathogenesis. This review highlights the progress and challenges in developing and implementing these molecular therapies. It discusses their mechanisms, efficacy, and the potential for personalized medicine in managing MG. The integration of new molecular therapies into clinical practice could significantly transform the treatment landscape of MG, offering more effective and tailored therapeutic options for patients who do not respond adequately to traditional treatments. These innovations underscore the importance of ongoing research and clinical trials to optimize therapeutic strategies and improve the quality of life for individuals with MG.
重症肌无力(MG)是一种慢性自身免疫性神经肌肉疾病,其特征为肌肉无力和疲劳。该疾病主要由神经肌肉接头处针对乙酰胆碱受体(AChR)和肌肉特异性激酶(MuSK)蛋白的抗体引起。MG 的传统治疗方法,如乙酰胆碱酯酶抑制剂、皮质类固醇和免疫抑制剂,已显示出疗效,但往往伴随着显著的长期副作用和可变的患者反应率。值得注意的是,约 15%的患者对这些标准疗法反应不足。最近在分子疗法方面的进展,包括单克隆抗体、B 细胞耗竭剂、补体抑制剂、Fc 受体拮抗剂和嵌合抗原受体(CAR)T 细胞疗法,为 MG 的治疗提供了有前途的替代方案。这些新的治疗方法为靶向 MG 发病机制中涉及的特定免疫途径提供了潜在的改进。本综述强调了开发和实施这些分子疗法的进展和挑战。它讨论了它们的机制、疗效以及在管理 MG 方面的个性化医疗的潜力。将新的分子疗法纳入临床实践可能会极大地改变 MG 的治疗格局,为那些对传统治疗反应不足的患者提供更有效和个性化的治疗选择。这些创新强调了持续研究和临床试验的重要性,以优化治疗策略并改善 MG 患者的生活质量。