The FDA approved nipocalimab (marketed as Imaavy) in May 2025 for generalized myasthenia gravis (gMG), marking a significant milestone as the first and only therapy designed to address the underlying cause of the disease in adults and adolescents aged 12 and older who possess specific antibodies associated with gMG. This approval provides a long-lasting treatment option for approximately 100,000 people affected by gMG in the United States, a condition characterized by severe muscle weakness, rapid fatigue, and challenges with speech and swallowing.
Breakthrough Mechanism of Action
Nipocalimab-aahu is a human IgG1 monoclonal antibody designed to target the neonatal Fc receptor (FcRn) with high affinity, thereby reducing circulating IgG levels. The approval was supported by results from the Phase 3 Vivacity-MG3 trial (ClinicalTrials.gov ID: NCT04951622), a randomized, double-blind, placebo-controlled study involving adult patients with generalized myasthenia gravis classified as class II to IV by the Myasthenia Gravis Foundation of America, who had an inadequate response to standard therapies, indicated by an MG-ADL score of 6 or above.
Robust Pipeline Development
According to DelveInsight's assessment, the global myasthenia gravis pipeline constitutes 20+ key companies continuously working toward developing 22+ treatment therapies. Companies actively developing therapies include Alpine Immune Science, Toleranzia, Cabaletta Bio, Rallybio, Alexion Pharmaceuticals, Takeda, Cartesian Therapeutics, RemeGen, and Horizon Therapeutics.
Emerging therapies in different phases of clinical trials include Povetacicept, TOL 2, MuSK-CAART, RLYB116, ALXN2050, TAK-079, Descartes-08, Telitacicept, and Inebilizumab, which are expected to have a significant impact on the myasthenia gravis market in the coming years.
Recent Clinical Advances
Cartesian Therapeutics' Sustained Results
In April 2025, Cartesian Therapeutics (NASDAQ: RNAC) reported 12-month efficacy and safety results from its Phase 2b trial of Descartes-08 in patients with generalized myasthenia gravis. Patients who received a single six-week treatment course of Descartes-08 showed sustained improvement in MG symptoms, which persisted through the 12-month follow-up evaluation.
The double-blind, placebo-controlled, crossover trial (NCT06038474) involved 36 heavily pre-treated, symptomatic patients. Half received placebo while the other half were treated with Descartes-08, both administered as six weekly outpatient infusions without prior chemotherapy preconditioning.
Telitacicept Phase 3 Success
Promising results from the Phase 3 clinical trial (NCT05737160) assessing the safety and efficacy of Telitacicept (RC18; brand name: 泰爱®) in patients with generalized myasthenia gravis were shared during the Late-Breaking Science Session at the 2025 American Academy of Neurology (AAN) Annual Meeting in April 2025.
Strategic Pipeline Decisions
In March 2025, Immunovant decided not to pursue regulatory approval for its myasthenia gravis treatment, batoclimab, despite the Phase III study meeting its primary endpoint of reducing disease symptoms. Instead, the company will leverage the data to further develop its alternative therapy, IMVT-1402. The Phase III randomized trial (NCT05403541) assessed the impact of weekly or bi-monthly doses of batoclimab on acetylcholine receptor antibody-positive (AChR+) patients, using the Myasthenia Gravis Activities of Daily Living (MG-ADL) score over a 12-week period.
Market Dynamics and Future Outlook
The myasthenia gravis pipeline encompasses various therapeutic approaches across different stages of development, from late-stage Phase III products to early-stage Phase I candidates and preclinical discoveries. The pipeline includes diverse molecule types such as monoclonal antibodies, small molecules, peptides, and vaccines, administered through various routes including infusion, subcutaneous, oral, and intramuscular delivery.
Market drivers include the increasing prevalence of myasthenia gravis, growing awareness regarding diagnosis options, and surge in geriatric population with autoimmune diseases. However, limited reimbursement policies and high treatment costs remain barriers to market growth.
The robust pipeline activity, combined with recent regulatory approvals and promising clinical results, suggests a transformative period ahead for myasthenia gravis treatment, potentially offering patients more effective and targeted therapeutic options.
