The 2025 update of the Association of British Neurologists guidelines for the management of autoimmune myasthenia gravis (MG) emphasises several points that are distinct from the 2015 guidelines based on recent research and publications. The main differences from the previous guidelines are: (1) The recommendation to prescribe daily steroids rather than the alternate day regimen is now standard practice. (2) There is a clear emphasis on the beneficial effects of early thymectomy. (3) Randomised controlled trial evidence now supports early use of rituximab (within 1 year of generalised disease onset), although the evidence is less robust, but still likely to be useful, in established treatment-refractory MG. (4) Finally, several clinical trials have been published for newer targeted therapies in MG, predominantly those that inhibit the complement and neonatal Fc gamma receptor pathways, the roles of which are being slowly established especially in patients unresponsive to conventional therapy.
Jacob et al. (2025) studied this question.