What is the biologic of choice in a patient with RA and myasthenia gravis?

There is no biologic of choice for patients with Myasthenia Gravis (MG). Given the disease's rarity, the data is scant. A prospective pilot trial of etanercept in 11 patients with corticosteroid-dependent observed that 6 of the 8 patients who completed the trial improved, based on quantitative measures of muscle strength and lowering of corticosteroid requirement. In contrast, there have been isolated case reports describing the development of MG in patients treated with etanercept or adalimumab.

Other biologics including ocrelizumab, abatacept, and tocilizumab are being studied as treatments for MG but there is no published data available.

Whichever biologic is selected, its potential effects on MG should be monitored carefully.