Authors of a prospective single-center cohort study examined relapse after complete treatment discontinuation in patients with myasthenia gravis (MG) who had achieved minimal symptom expression (MSE). Among 196 patients from the Huashan MG Registry, 55.1% relapsed after stopping all MG therapies, with a median relapse-free survival of 49.7 months. Patients who remained stable generally had longer total treatment duration, a longer period of treatment continuation after reaching MSE, and were more likely to have received rituximab (RTX). Those who relapsed tended to be older at onset and had shorter treatment courses. Common relapse triggers included infection, fatigue, and psychological stress. Most relapses were mild and often involved extraocular symptoms.

Multivariate analysis identified four key prognostic factors: onset age 50 years or older increased relapse risk, whereas prior RTX exposure, treatment duration of at least 14.3 months, and continuing treatment for at least 6.1 months after reaching MSE were independently protective. Patients with repeated discontinuation attempts appeared especially vulnerable. All 20 patients in that subgroup relapsed after the first discontinuation and 65% relapsed again after a second attempt, often with a shorter relapse-free interval. The authors conclude that complete treatment discontinuation in MG carries a substantial risk of relapse. They suggest that decisions about stopping therapy should be individualized, with extra caution in patients with older-onset disease and with attention to prior treatment history and a longer post-remission consolidation period. They also note that larger multicenter studies and biomarker-based approaches are still needed to improve relapse prediction and guide practice.

Reference: He D, Yan C, Wang B, et al. Who Can Safely Discontinue Treatment in Myasthenia Gravis? Insights From a Long-Term Real-World Study. Eur J Neurol. 2026 Mar;33(3):e70569. doi: 10.1111/ene.70569.

Authors of this retrospective single-center study evaluated mycophenolate mofetil (MMF) in 11 patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) who had suboptimal responses to first-line therapy and required treatment escalation, comparing them with 33 patients maintained on IVIg alone. MMF was added to high-dose IVIg with or without corticosteroids, then titrated to a median dose of 3 g/day. After 12 months, MMF was associated with significant improvement in key clinical outcomes, including Medical Research Council Sum Score and I-RODS disability scores, with most patients improving beyond minimal clinically important difference thresholds. Median IVIg dose did not significantly decline overall, but half of patients were maintained on lower IVIg doses, and post-MMF IVIg requirements were similar to those of the comparator group.

The addition of MMF was also associated with a significant reduction in day care unit utilization, which translated into substantial estimated annual cost savings of about £38,400 per patient when IVIg and infusion delivery costs were combined. MMF was generally well tolerated, with no major treatment-related adverse events or discontinuations reported. The authors conclude that MMF may be a useful, relatively inexpensive, and well-tolerated option for difficult-to-treat CIDP, especially for patients with residual disability or unstable disease despite IVIg, while also emphasizing that the findings are limited by the study’s retrospective design, small sample size, single-center setting, and non-equivalent comparator group. They argue that these results support the need for a larger prospective randomized trial to clarify MMF’s role in the CIDP treatment pathway.

Reference: Miah S, Japzon N, Elsaddig A, et al. Mycophenolate facilitates improvement in outcome measures in treatment resistant chronic inflammatory demyelinating polyradiculoneuropathy. Muscle Nerve. 2025 Aug;72(2):250-257. doi: 10.1002/mus.28436.

This review looks at myasthenia gravis (MG) in the context of pregnancy and emphasizes that disease course during pregnancy is highly variable. MG most often affects women during reproductive years, and symptoms may worsen during the first trimester or postpartum, improve later in pregnancy, or remain stable. The paper stresses the importance of preconception counseling, multidisciplinary care, and individualized treatment planning, including avoiding teratogenic drugs such as methotrexate and mycophenolate before conception, while noting that pyridostigmine, corticosteroids, and azathioprine are generally considered safer options during pregnancy. It also highlights practical obstetric guidance, including preference for vaginal delivery when possible, avoidance of magnesium and certain sedatives during labor, and close neonatal monitoring because maternal antibodies can cross the placenta and cause transient neonatal myasthenia gravis.

The review also focuses on biomarkers that may improve diagnosis, prognosis, and treatment monitoring in MG, especially during pregnancy. Established antibody biomarkers include AChR, MuSK, LRP4, titin, ryanodine receptor, and agrin antibodies, but the authors note that better disease-specific biomarkers are still needed because antibody levels do not always track with severity or treatment response. Beyond autoantibodies, the paper highlights non-coding RNAs, especially circulating microRNAs and long non-coding RNAs, as promising emerging biomarkers because they can be detected in body fluids and may help with earlier diagnosis, subtype identification, and monitoring of therapeutic response. Overall, the authors conclude that more high-throughput and subgroup-specific research is needed to clarify how these biomarkers can be used in routine MG care and in pregnancy-related management.

Reference: Gerede A, Danavasi M, Oikonomou E, et al. Myasthenia Gravis in Pregnancy: Prenatal and Postnatal Diagnostic Challenges-A Narrative Review. Diagnostics (Basel). 2026 Mar 18;16(6):899. doi: 10.3390/diagnostics16060899.