With the exception of thymectomy, immune modulatory treatment strategies and clinical trials in myasthenia gravis over the past 50 y were mainly borrowed from experience in other nonneurologic autoimmune disorders. The current experimental therapy paradigm has significantly changed such that treatments directed against the pathological mechanisms specific to myasthenia gravis are being tested, in some cases as the initial disease indication. Key advances have been made in three areas: (i) the expanded role and long‐term benefits of thymectomy, (ii) complement inhibition to prevent antibody‐mediated postsynaptic membrane damage, and (iii) neonatal Fc receptor (FcRn) inhibition as in vivo apheresis, removing pathogenic antibodies. Herein, we discuss these advances and the potential for these newer therapies to significantly influence the current treatment paradigms. While these therapies provide exciting new options with rapid efficacy, there are anticipated challenges to their use, especially in terms of a dramatic increase in cost of care for some patients with myasthenia gravis.

中文翻译：

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重症肌无力的免疫介导疗法的最新进展。

除胸腺切除术外，过去50年来重症肌无力的免疫调节治疗策略和临床试验主要借鉴了其他非神经系统自身免疫性疾病的经验。当前的实验疗法范例已发生了重大变化，以致针对重症肌无力的特定病理机制的治疗方法正在接受测试，在某些情况下可作为初始疾病的指征。在三个领域取得了重要进展：（i）胸腺切除术的作用和长期益处不断扩大；（ii）补体抑制以防止抗体介导的突触后膜损伤；以及（iii）新生儿Fc受体（FcRn）抑制如体内血液分离，去除病原性抗体。在这里 我们讨论了这些进展以及这些新疗法可能显着影响当前治疗范例的潜力。尽管这些疗法提供了激动人心的新选择，且疗效迅速，但人们仍有望对其使用提出挑战，特别是在某些重症肌无力患者的护理费用急剧增加方面。