Predicting Patient Response in the Move Toward Precision Medicine in Myasthenia Gravis

In part 3 of an interview with The American Journal of Managed Care^®, Kiran Bhavaraju-Sanka, MD, and Beth Stein, MD, focus on how to optimize patient treatment selection for myasthenia gravis (MG). They discuss important considerations in the move toward a precision medicine approach in the space that include MG immunopathologic basis, defining disease subgroup, and patient comorbidities.

Bhavaraju-Sanka is the John H. Doran, MD, FACP, Endowed Chair in Peripheral Neuropathy at UT Health San Antonio, and Stein is the chief of neurology at St. Joseph’s Health.

Rewatch part 1 of their interview to learn about ensuring broad access to new MG treatments and part 2, where they address the roles of holistic care and patient-physician collaboration.

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

Transcript

Will it be possible one day to predict patient response to enable a more personalized and effective MG treatment selection process?

Beth Stein, MD: I think as we understand the immunopathologic basis of MG, we're able to establish and understand patient characteristics. Subtypes are developed based on the mechanism, the pathogenic mechanism, at the neuromuscular junctions, antibody mediated, and understanding those targets and understanding the antibody involved in each patient can help us establish which patients are going to respond to which targeted therapy. These MG subgroups are based on antibody status, histopathology of thymoma, age of onset of symptoms, and muscular involvement. Understanding where our patients are within those subgroups will help us choose the correct targeted therapy for that patient. Once you can attain and understand which therapy is best for that patient, you'll be able to follow them and determine which patients are going to respond better. You can personalize and tailor their care based on understanding their subgroup and using precision medicine to lead to more effective treatment.

Ratna Kiran Bhavaraju-Sanka, MD: I agree with Dr. Stein. I think we know that different antibodies work differently at the neuromuscular junction, and knowing how their mechanism of action is and targeting that specific action is what we can do with selecting the treatments. But we also need to put in the patient comorbidities. There are certain comorbidities that make them not be the right candidate of certain therapies, so I think that also needs to be put in the equation to create or to predict what they can respond to based on available literature from the studies and what they may not respond to. What [side effects] they may have based on their comorbidities is how we can make it more precision care.