Holistic, Collaborative Care Necessary for Successful Myasthenia Gravis Treatment

There is a critical need for a close doctor-patient relationship, as patients who have myasthenia gravis often require long-term monitoring and management, including ongoing vigilance to assess treatment response and outcomes, explain Beth Stein, MD, chief of neurology, St. Joseph’s Health, and Ratna Kiran Bhavaraju-Sanka, MD, the John H. Doran, MD, FACP, Endowed Chair in Peripheral Neuropathy, UT Health San Antonio. In this interview, they also focus on mechanism-specific monitoring, patient education and empowerment, and applying real-world evidence.

To learn about key factors necessary to ensure broad access to new myasthenia gravis treatments, rewatch part 1 of their interview.

This transcript was lightly edited for content; captions were auto-generated.

Transcript

How should long-term patient management be tailored to different drug mechanisms of action?

Beth Stein, MD: I think it's really important to develop a very close relationship with your patient in order to monitor specific responses to medication, their long-term benefits and then adjust their medications based on their responses. You’re only able to do that by creating close relationships with your patients, [and] consistent, ongoing care both via telephone/telemedicine and in-person visits. That's the only way to address long-term strategies for monitoring patients and also adverse events that occur. Not only looking at the clinical trials, but in real-world practice, the only way to do that is by developing close relationships with your patients, active relationships with your patients, where everybody's involved: the patient, the patient’s caregiver, and the health care provider.

Ratna Kiran Bhavaraju-Sanka, MD: And also, with different therapies, they work differently, as their mechanisms of action are different. We need to look at the effects of these medications all through the course of their action. Some of the FcRns [the neonatal Fc receptor], they reduce your IgG [immunoglobulin G]; how much does that impact patients with their different molecules? Not only pathogenic, but other important IgGs can be lowered. Does that increase the risk of infections? Do they have comorbidities that we cannot use these? Are they immunodeficient? Can they cause more symptoms? With complement inhibitors, we've seen that vaccination is really important because the complement is important for prevention of some certain diseases, infections, so we need to be proactive and continue monitoring them and educate the patient of what to be looking forward to and what to report to us, because a lot of times, it's a 2-way street.

We need to monitor for these patient side effects, but the patients also need to be monitoring them. With the B-cell therapies also, we have some information based on its utilization in oncology and then our NMO [neuromyelitis optica] colleagues, so we need to take every information we have and educate ourselves about how they work upstream, downstream, what are their other effects that we may not have realized, and keep them in the perspective we are seeing these. Sometimes we've seen some complications happen years later, after we stop the therapy, so we need to be looking at them. Some of these data exist because some drugs have been used in oncology, but some don't. That's where we have to keep our eyes and ears open and talk to the patients and educate them that they need to reach out to us for any changes that are unusual.