Abstract

(Excerpt from 2025 guidelines.)

The previous Association of British Neurologists (ABN) myasthenia gravis (MG) guidelines, published in 2015, were based on evidence where available, and expert opinion. Several recent MG guidelines have been published by other national MG societies. It is therefore appropriate to revise the ABN MG guidelines to reflect current practice and review future opportunities.

Therefore, where the evidence is too limited, where there is a range of treatment options or when the disease is difficult to manage, the guidelines direct the managing neurologist to seek the advice of a neurologist with a specialist interest in MG.

These guidelines can only offer suggestions on how to manage common clinical scenarios. This document is intended to offer guidance to general neurologists - it can be followed closely or used flexibly, depending on the level of clinical experience and the patient circumstances. It also gives brief information on newer therapies that are likely to be used in the specialist setting.

Myasthenia gravis symptoms vary, and so patients should be managed as far as possible by one clinician. A myasthenia specialist nurse or neuromuscular advisor, if available, should be involved in the care of patients.

All patients should receive the contact details of their named clinician in case of clinical deterioration and should be aware of patient information literature available from myaware.

The UK Medicines and Healthcare Products Regulatory Agency regularly updates its advice on the use of a range of medication. Please refer to contemporaneous advice on the uses and interactions of the medications discussed in these guidelines.

These guidelines can only offer suggestions on how to treat common clinical scenarios. This document is intended to offer guidance: it could be followed to the letter or used flexibly. Individuals with myasthenia vary, so it is assumed that clinicians will select therapy accordingly.

Main Changes from 2015 Guidelines:

1. The recommendation to prescribe daily steroids rather than alternative 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)
4. Several clinical trials have been published for newer targeted therapies in MG.

Read the 2025 ABN guidelines here.