About 85% of patients with generalized myasthenia gravis (gMG)–an autoimmune disease of the neuromuscular junction caused by antibodies that attack components of the postsynaptic membrane, impair neuromuscular transmission, and therefore cause weakness and fatigue of skeletal and bulbar muscles–have demonstrable IgG autoantibodies. These autoantibodies exert a direct pathogenic effect that results in impaired neuromuscular transmission. Most currently available treatments, including corticosteroids and nonsteroidal immunosuppressive therapies, broadly suppress the immune system and do not selectively target those IgG autoantibodies central to generalized myasthenia gravis pathophysiology. In addition, these treatments often provide only limited symptom relief and—especially in the case of steroids—are associated with treatment-limiting side-effects. A new approach that addresses that unmet need involves predictable lowering levels of pathogenic autoantibodies. In MG, the neonatal Fc receptor (FcRn) is a major factor regulating the serum levels of IgG antibodies. While FcRn-mediated half-life extension is beneficial for IgG antibody responses against pathogens, it also prolongs the serum half-life of IgG autoantibodies and thus promotes tissue damage in autoimmune diseases such as MG. A mutated antibody to the FcRn can block that IgG-associated damage and potentially improve outcomes and treatment tolerance in generalized MG. The FDA has now approved drugs that target FcRn-mediated antibody recycling and can improve patient outcomes while reducing the need for corticosteroids.
Pharmacy professionals play an important role in the new era of recently approved therapeutic options to treat patients with gMG. Whether working in the hospital, in a neuromuscular clinic, or in an infusion center, pharmacists play a key role in supporting patient care, preparing and delivering these medications, and evaluating comorbidities and concomitant medications of interest. It is important for pharmacists involved in the care of patients with gMG to be well-informed about the pathophysiology of gMG, the reason why FcRn-targeted therapy can be beneficial, and about the multiple ways pharmacists can help improve patient comfort, satisfaction, and outcomes with this therapy.
Pharmacists, pharmacy technicians and other healthcare professionals who care for patients with myasthenia gravis
- Review the pathology, concerns for disease augmentation from other medications, potential for associated glucocorticoid toxicity, and specific unmet needs of patients with gMG
- Discuss the mechanisms of action, pharmacology, and clinical trial data for current FcRn and complement inhibitor therapeutics to treat gMG
- Review patient educational needs, updated route of administration, and strategies to minimize potential drug-drug interactions and optimize adherence to treatment
I. Generalized Myasthenia Gravis Update: Pathology, Disease Augmentation from Drug Interactions, Concern for Glucocorticoid Toxicity, and Unmet Patient Needs
II. Pharmacology, MOA, and Clinical Trial Data for Newer Therapeutics to Treat gMG
III. Strategies to Improve Outcomes through Patient Education, Addressing Barriers to Care, Minimizing Potential Drug-Drug Interactions, and Optimizing Adherence to Treatment
Disclosures of Relevant Financial Relationships
It is the policy of AcademicCME that all faculty, instructors, and planners disclose relevant financial relationships relating to the topics of this educational activity. Any relevant financial relationships are mitigated via a content review by planning committee members and faculty with no relevant financial relationships.
The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CE activity:
|Relationship Identified With:
|Kipp Tiger, PharmD, CSP (Course Chair)
|Nothing to disclose
|Alexis El-Khouri, PharmD
|Nothing to disclose
|Claire Spahn, PharmD
|Nothing to disclose
Planners and Peer Reviewers
Timothy Hayes, MD, PhD; Kim Cheramie, MSN, RN-BC; Nicole McMenamin and Chelsey Simonds hereby state that they or their spouse/life partner do not have any relevant financial relationships to products or devices with any commercial interests related to the content of this activity of any amount during the past 12 months.
In support of improving patient care, AcademicCME is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Credit Designation Statements
AcademicCME designates this continuing education activity for 1.50 CPE Contact Hour (0.15s CEUs) of continuing pharmacy education credit (UAN JA4008190-0000-24-001-H01-P).
Pharmacists should only claim credit commensurate with the extent of their participation.
This activity has been supported by an independent educational grant from argenx.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. AcademicCME and argenx do not recommend the use of any agent outside of the labeled indications.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Method of Participation
In order to claim credit, participants must complete the following:
- Read the learning objectives, accreditation information and faculty disclosures at the beginning of this activity.
- Complete the Pre-Activity Questions
- Read or Review the activity content.
- Complete the Post-Activity Test Questions and Evaluation.
- Learners who receive a grade of 66% or better on the Post-Activity Test Questions and complete the Evaluation will receive appropriate credit as indicated (CME, CNE, and/or CPE credit).
- CME and CNE credit will be issued appropriate certificate of completion.
- Others may request a “certificate of completion”.
- Learners should claim only the credit commensurate with the extent of their participation in the activity.
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