The MG You’re Missing: Recognizing and Managing MuSK+, LRP4+, and Triple-Seronegative Myasthenia Gravis

Despite advances in generalized myasthenia gravis (gMG), muscle-specific tyrosine kinase (MuSK+), low density lipoprotein receptor related protein 4 (LRP4+), and triple-seronegative MG remain underrecognized and are often managed using paradigms derived from acetylcholine receptor (AChR)-positive disease. Neurologists, neuromuscular specialists, nurse practitioners (NPs), and physician associates (PAs) who evaluate adults with suspected or confirmed gMG need education to improve subtype appropriate diagnostic evaluation, interpret serologic and electrodiagnostic results, apply mechanism-informed treatment strategies, and distinguish current regulatory labeling from evidence supported and investigational approaches. Education should also strengthen clinicians’ ability to establish individualized treatment goals and longitudinal monitoring using validated measures that capture bulbar and respiratory symptoms, fatigue, treatment burden, and quality of life. Addressing these learning gaps will support earlier recognition of non-AChR MG subtypes, more appropriate therapeutic decision-making, and more patient-centered, coordinated care for these historically underserved populations.

In this CME Outfitters recorded Grand Rounds initiative, expert faculty will guide learners in applying diagnostic and treatment strategies for these subtypes, clarifying interprofessional roles, and using patient centered goals and validated measures to support coordinated monitoring and care over time.

At the conclusion of this activity, learners will be able to better:

• Identify appropriate diagnostic testing strategies to detect MuSK+, LRP4+, and triple-seronegative MG
• Select treatment strategies aligned with disease mechanism, available evidence, and current therapeutic context in MuSK+, LRP4+, and triple-seronegative MG
• Outline the roles and responsibilities of interprofessional healthcare team members in individualized treatment goals and validated outcome measures used to monitor response in patients with MuSK+, LRP4+, and triple-seronegative MG

Supported by an educational grant from argenx US Inc.

Primary: Neurologists, neuromuscular specialists, nurse practitioners (NPs), and physician associates (PAs) who evaluate adults with suspected or confirmed gMG; interpret serologic and electrodiagnostic testing; select immunotherapies; and monitor longitudinal response and treatment burden in antibody-defined and seronegative MG populations.

Secondary: Neuro-ophthalmologists, emergency/hospital clinicians, pulmonologists/critical care clinicians, speech-language pathologists, specialty pharmacists, infusion nurses, rehabilitation clinicians, and primary care clinicians who contribute to early recognition, medication safety, exacerbation triage, and coordinated longitudinal supportive care.

It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and mitigated any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.

Faculty

Dr. Hehir reports the following financial relationships:

Consultant: argenx; Dianthus Therapeutics, Inc.; Johnson & Johnson; and UCB, Inc.

Dr. Rosenfeld reports the following financial relationships:

Consultant: Annexon, Inc.; BridgeBio Pharma, Inc.; and UCB, Inc.

Grants: argenx; Novartis Pharmaceuticals Corporation; and Shionoghi Inc.

Speakers Bureau: Alexion Pharmaceuticals, Inc.; argenx; Johnson & Johnson; Shionoghi Inc.; and UCB, Inc.

Patient Planners

Jennifer Januario reports no financial relationships to disclose.

Terri Justick reports no financial relationships to disclose.

The following individuals have no financial relationships to disclose:

Jeffrey Helfand, DO (Peer Reviewer)
Albert Eubanks, Jr., RN (Peer Reviewer)
Mary Gleason, PhD, CHCP (Planning Committee)
Felicia Oyedepo, MD (Planning Committee)
Andrea Perseghin, EdD (Planning Committee)
Sandra Caballero, PharmD (Planning Committee)
Sharon Tordoff (Planning Committee)

*All identified conflicts of interest have been mitigated.

Unlabeled Use Disclosure
Faculty of this CME/CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices. CME Outfitters, LLC, the faculty, planners, and reviewers do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.

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