Transcript
Announcer:
This is NeuroFrontiers on ReachMD. Today, Dr. Shruti Raja will be discussing immunologic phenotyping for personalized treatment selection in myasthenia gravis. Dr. Raja is an Associate Professor of Neurology at Duke Health in Durham, North Carolina, and she spoke about this subject at the 2026 AANEM Annual Meeting. Here’s Dr. Raja now.
Dr. Raja:
In terms of using immunopathogenesis to guide therapy, what we are really missing is a way to distinguish which mechanism is at work in which individual. We have acetylcholine receptor antibodies that can work in a number of different ways. And, in many cases now, we are functioning in a system where we are trying one therapy, and if it doesn't work, we're adding on another, or we're switching to another.
What would be really fabulous—and I think really accelerate therapy and disease control for a patient—is to be able to know or be able to send to a lab a test that will tell us exactly how the patient's primary antibody that is driving the immunologic MG is functioning.
If we know right off the bat that a specific individual has a phenotype of antibody that fixes complement, then I would consider a complement inhibitor earlier in that patient's course, versus something like an FcRn antagonist. If we find that this is more about actual blockade of the function of the acetylcholine receptor, then maybe an FcRn blockade would be more effective. And then, if we're dealing with something like a MuSK MG patient, we know that complement inhibition doesn't work, because IgG4 doesn't fix complement. FcRn blockade could work, but what about stopping the actual production of the antibody, which is where the B-cell directed therapies come into play?
What we really need is head-to-head trials comparing the different therapies within a class to each other, as well as across different classes. And what we need to be able to do is immunologically phenotype each individual to determine what is the difference between a responder versus a non-responder.
Announcer:
That was Dr. Shruti Raja talking about the role of immunologic phenotyping in myasthenia gravis care. To access this and other episodes in our series, visit NeuroFrontiers on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!
