Myasthenia gravis: immunoglobulins as maintenance therapy?

Polyvalent immunoglobulins (Ig) have been shown to be effective in treating exacerbations of myasthenia gravis (myasthenic seizure). The results of two retrospective studies, published in 2021, testify to their interest also in background regimen.


Effective enough to lighten the rest of the prescription

The first study, Canadian, involved 34 patients with generalized myasthenia gravis treated with intravenous (IV) or subcutaneous (SC) Ig every three to four weeks for an average of three years. This treatment resulted in:

  • a significant improvement in the Myasthenia Gravis Impairment Index (MGII) severity score from 27.7 ± 15.7 to 22 ± 17.4 after IVIG, or 19.5 ± 18.1 for IgSC,
  • a significant reduction in the mean dose of pyridostigmine (from 284.1 to 204.7 mg), the mean number of immunosuppressants (from 1.5 to 1) and the mean dose of corticosteroids (from 17.9 to 10.3 mg), 
  • infrequent and minor side effects (headache, chills, injection site reactions).


A cortisone-sparing effect 

The second Israeli study included 109 participants with severe ocular form (n = 3) or generalized myasthenia gravis. Low-dose IVIG infusions (0.4 mg / kg) every three to four weeks, for an average of three years, have resulted in: 

  • a drop of at least one point in the Myasthenia Gravis Foundation of America (MGFA) score in 61.4% of participants, 
  • a decrease in the mean prednisone dose from 33.1 ± 14.5 mg to 7.2 ± 7.8 mg after three years of IVIg, with the greatest effect after six months (17.9 ± 11 , 7 mg).

The authors of both studies call for a prospective randomized controlled trial to confirm their results. However, regular strains of Ig supplies could limit their wider use in myasthenia gravis. 


Chronic immunoglobulin maintenance therapy in myasthenia gravis. Alcantara M, Sarpong E, Barnett C et al. Eur J Neurol. 2021 Feb;28(2):639-646.


Chronic low-dose intravenous immunoglobulins as steroid-sparing therapy in myasthenia gravis. Wilf-Yarkoni A, Lotan I, Steiner I, Hellmann MA. J Neurol. 2021 Apr 7.