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Myasthenia Gravis Treatments Compared

Name: Myasthenia Gravis Treatments Compared
Creator: Jason Hunter
Published: 2026-10-01

7 FDA-approved drugs, side by side from the current prescribing labels. Newest label Aug 2026. Checked October 1, 2026.

FcRn blockersVyvgart · Rystiggo · Imaavy

Complement C5 inhibitorsSoliris · Ultomiris · Zilbrysq

B-cell depletionUplizna

Seven targeted drugs are FDA-approved for generalized myasthenia gravis, and they fall into 3 groups. Vyvgart, Rystiggo and Imaavy block FcRn to clear the harmful antibodies; Soliris, Ultomiris and Zilbrysq block complement protein C5; Uplizna removes the B cells that make the antibodies. Five are clinic infusions, Rystiggo is a pump infusion under the skin given by a clinician, Zilbrysq is a daily self-injection, and Vyvgart also comes as a weekly under-the-skin version. The 3 complement blockers carry a boxed warning for meningococcal infection and require vaccination. Every pivotal trial measured the MG-ADL daily-living score against placebo, with drug-minus-placebo differences of 1.5 to 2.6 points, but the trials used different time points and populations, so the numbers do not rank the drugs.

Side by side

7 approved myasthenia gravis treatments at a glance

How each drug is given, how often, who it is approved for and when it was first approved, from the current FDA label.

Myasthenia Gravis treatments compared: route, schedule, approved use and approval date
Drug	How it is given	How often	Approved for	First approved
Soliris eculizumab Alexion (AstraZeneca)	IV infusion at a clinic every 2 weeksAbout 35 minutes per dose	900 mg weekly for 4 weeks, then 1,200 mg at week 5, then 1,200 mg every 2 weeks	Adults and children 6 and older with generalized MG who are AChR antibody positive	October 23, 2017
Vyvgart efgartigimod alfa-fcab argenx	IV infusion over 1 hour at a clinic, in cyclesAbout 60 minutes per dose	10 mg/kg once weekly for 4 weeks per cycle; next cycle timed by your doctor's evaluation	Adults with generalized MG (current label is not limited by antibody status)	December 17, 2021
Rystiggo rozanolixizumab-noli UCB	Under-the-skin infusion by pump, given by a healthcare provider, in cycles	Once weekly for 6 weeks per cycle, dose by body weight (420, 560 or 840 mg); next cycle on evaluation, not sooner than 63 days from the start of the last cycle	Adults with generalized MG who are AChR or MuSK antibody positive	June 26, 2023
Zilbrysq zilucoplan UCB	Daily shot under the skin, self-injected at home	Once daily, dose by body weight (16.6, 23 or 32.4 mg prefilled syringe)	Adults with generalized MG who are AChR antibody positive	October 17, 2023
Ultomiris ravulizumab-cwvz Alexion (AstraZeneca)	IV infusion at a clinic every 8 weeks	Weight-based loading dose, then a maintenance dose 2 weeks later and every 8 weeks after that	Adults with generalized MG who are AChR antibody positive	April 28, 2022
Uplizna inebilizumab-cdon Amgen	IV infusion at a clinic, about 90 minutes, twice a year after 2 starting dosesAbout 90 minutes per dose	300 mg, a second 300 mg dose 2 weeks later, then 300 mg every 6 months	Adults with generalized MG who are AChR or MuSK antibody positive	December 11, 2025
Imaavy nipocalimab-aahu Johnson & Johnson	IV infusion at a clinic every 2 weeksAbout 15 minutes per dose	30 mg/kg starting dose over at least 30 minutes, then 15 mg/kg every 2 weeks over at least 15 minutes	Adults and children 12 and older with generalized MG who are AChR or MuSK antibody positive	April 29, 2025

The calendar

A year on each myasthenia gravis treatment

Every dose in a year, drawn to the label schedule, so the difference between a daily pill and a twice-yearly infusion is the picture.

Soliris

Infusion, at a clinic

26 doses a year

Vyvgart

Infusion, at a clinic

10 mg/kg once weekly for 4 weeks per cycle (no fixed yearly count)

Rystiggo

Infusion, at a clinic

Once weekly for 6 weeks per cycle, dose by body weight (420, 560 or 840 mg) (no fixed yearly count)

Zilbrysq

Injection, at home

365 doses a year

Ultomiris

Infusion, at a clinic

Weight-based loading dose, then a maintenance dose 2 weeks later and every 8 weeks after... (no fixed yearly count)

Uplizna

Infusion, at a clinic

2 doses a year

Imaavy

Infusion, at a clinic

26 doses a year

Counts follow the label schedule for a full year on the maintenance dose. Drugs given in cycles or adjusted to blood tests have no fixed count, so their schedule is written out instead.

The evidence

What the pivotal myasthenia gravis trials showed

The primary result from the trial each FDA approval rests on, as reported on the label.

Before you compare

How to read the myasthenia gravis trial results

1
Antibody status decides eligibility
Soliris, Ultomiris and Zilbrysq are approved only for people who test positive for AChR antibodies. Rystiggo, Uplizna and Imaavy cover AChR-positive and MuSK-positive disease. The current Vyvgart label covers adults with generalized MG without an antibody qualifier.
2
The primary results are not a ranking
Vyvgart reports the share of responders during the first cycle, while the others report the average MG-ADL change at different time points, from day 43 for Rystiggo to week 26 for Soliris, Ultomiris and Uplizna. REGAIN, the Soliris trial, enrolled people who had failed other treatments, and MINT, the Uplizna trial, required steroid tapering during the study.
3
Age limits differ
Soliris is approved from age 6 and Imaavy from age 12; the other 5 are for adults.

Myasthenia Gravis pivotal trial results by drug
Drug	Pivotal trial	Primary result
Soliris eculizumab Alexion (AstraZeneca)	REGAIN (ECU-MG-301), 125 adults Trial record or paper	MG-ADL fell 4.2 points vs 2.3 on placebo at week 26 (1.9-point difference)
Vyvgart efgartigimod alfa-fcab argenx	ADAPT (Study 1), 167 adults Trial record or paper	68% of AChR+ patients were MG-ADL responders in cycle 1 vs 30% on placebo
Rystiggo rozanolixizumab-noli UCB	MycarinG (Study 1), 200 adults Trial record or paper	MG-ADL fell 3.4 points vs 0.8 on placebo at day 43 (2.6-point difference)
Zilbrysq zilucoplan UCB	RAISE (Study 1), 174 adults Trial record or paper	MG-ADL fell 4.39 points vs 2.30 on placebo at week 12 (2.09-point difference)
Ultomiris ravulizumab-cwvz Alexion (AstraZeneca)	CHAMPION-MG (ALXN1210-MG-306), 175 adults Trial record or paper	MG-ADL fell 3.1 points vs 1.4 on placebo at week 26 (1.6-point difference)
Uplizna inebilizumab-cdon Amgen	MINT (Study 3), 238 adults Trial record or paper	MG-ADL fell 4.2 points vs 2.2 on placebo at week 26 (1.9-point difference)
Imaavy nipocalimab-aahu Johnson & Johnson	Vivacity-MG3 (gMG Study 1), 196 adults Trial record or paper	MG-ADL fell 4.7 points vs 3.3 on placebo over weeks 22 to 24 (1.5-point difference)

Safety

Myasthenia Gravis treatment side effects and warnings

Soliris, Zilbrysq and Ultomiris carry a boxed warning, the FDA's strongest. The rest list their main precautions.

Myasthenia Gravis treatments: most common side effects and key warnings from the FDA labels
Drug	Most common side effects	Key warning
Soliris eculizumab Alexion (AstraZeneca)	musculoskeletal pain 15%, abdominal pain 8% and herpes simplex infections 8%	Boxed warning Boxed warning: serious meningococcal infections. Meningococcal vaccination required; available only through a REMS program.
Vyvgart efgartigimod alfa-fcab argenx	respiratory tract infections 33%, headache 32% and urinary tract infections 10%	No boxed warning. Infections, hypersensitivity reactions including anaphylaxis, and infusion reactions.
Rystiggo rozanolixizumab-noli UCB	headache 44%, infections 23% and diarrhea 20%	No boxed warning. Infections, aseptic meningitis, hypersensitivity reactions.
Zilbrysq zilucoplan UCB	injection site reactions 29%, upper respiratory tract infections 14% and diarrhea 11%	Boxed warning Boxed warning: serious meningococcal infections. Vaccination required; REMS program. Also pancreatitis and pancreatic cysts.
Ultomiris ravulizumab-cwvz Alexion (AstraZeneca)	diarrhea 15%, upper respiratory tract infection 14% and dizziness 9%	Boxed warning Boxed warning: serious meningococcal infections. Vaccination required; REMS program.
Uplizna inebilizumab-cdon Amgen	headache 15%, infusion-related reactions 10% and nasopharyngitis 7%	No boxed warning. Infusion reactions (premedication required), serious infections including hepatitis B reactivation, low immunoglobulin levels.
Imaavy nipocalimab-aahu Johnson & Johnson	respiratory tract infections 18%, peripheral edema 12% and muscle spasms 12%	No boxed warning. Infections, hypersensitivity reactions including anaphylaxis, infusion reactions.

Cost

Help paying for myasthenia gravis treatment

Drugmaker copay and free-drug programs, plus charity funds for the condition, checked every week.

Questions

Myasthenia Gravis treatment questions people ask

What is the newest treatment for myasthenia gravis?

Uplizna (inebilizumab) is the most recent FDA approval for generalized myasthenia gravis, on December 11, 2025, for adults who are AChR or MuSK antibody positive. Imaavy (nipocalimab) was approved on April 29, 2025. Both are listed in the table on this page with their trial results from the FDA label.

Which myasthenia gravis drugs can be taken at home?

Zilbrysq (zilucoplan) is a once-daily shot under the skin that patients give themselves. Vyvgart Hytrulo, the under-the-skin version of Vyvgart, can be self-injected once a week for 4 weeks per cycle. Rystiggo is also given under the skin but by a healthcare provider using a pump, and Soliris, Ultomiris, Uplizna and the IV form of Vyvgart are clinic infusions.

Which myasthenia gravis drugs have a boxed warning?

The 3 complement inhibitors, Soliris, Ultomiris and Zilbrysq, carry a boxed warning for serious meningococcal infections and require vaccination and enrollment in a safety program before the first dose. The FcRn blockers Vyvgart, Rystiggo and Imaavy, and the B-cell drug Uplizna, have no boxed warning; their main warnings are infections and infusion or hypersensitivity reactions.

Is Vyvgart better than Rystiggo?

No trial has compared them. In its own trial, 68% of AChR-positive patients on Vyvgart were MG-ADL responders in the first cycle against 30% on placebo. Rystiggo's trial reported a 2.6-point greater MG-ADL improvement than placebo at day 43. Vyvgart is given weekly for 4 weeks per cycle, Rystiggo for 6 weeks per cycle, and both repeat cycles on the doctor's judgment. Rystiggo's label also covers MuSK-positive disease; the current Vyvgart label covers generalized MG with no antibody qualifier.

Which myasthenia gravis treatment is given least often?

Uplizna, after 2 starting doses 2 weeks apart, is a clinic infusion once every 6 months. Ultomiris is every 8 weeks after a loading dose. The FcRn blockers run in cycles of weekly doses, Soliris and Imaavy are every 2 weeks, and Zilbrysq is daily.

Go deeper

More on Myasthenia Gravis at Trial Friend

Sources

Where every number on this page comes from

Approved-drug facts are from the current FDA prescribing information on DailyMed, with the label's effective date. Investigational-drug facts are from ClinicalTrials.gov and the sources named in each row.

Soliris (eculizumab) prescribing information, Alexion (AstraZeneca), label dated Jul 2026. DailyMed. Pivotal trial: ClinicalTrials.gov
Vyvgart (efgartigimod alfa-fcab) prescribing information, argenx, label dated May 2026. DailyMed. Pivotal trial: publication
Rystiggo (rozanolixizumab-noli) prescribing information, UCB, label dated Jan 2026. DailyMed. Pivotal trial: publication
Zilbrysq (zilucoplan) prescribing information, UCB, label dated Feb 2026. DailyMed. Pivotal trial: ClinicalTrials.gov
Ultomiris (ravulizumab-cwvz) prescribing information, Alexion (AstraZeneca), label dated Oct 2025. DailyMed. Pivotal trial: ClinicalTrials.gov
Uplizna (inebilizumab-cdon) prescribing information, Amgen, label dated Dec 2025. DailyMed. Pivotal trial: ClinicalTrials.gov
Imaavy (nipocalimab-aahu) prescribing information, Johnson & Johnson, label dated Aug 2026. DailyMed. Pivotal trial: publication

This page compares what the FDA labels and pivotal trials report. It is not medical advice, and no trial on this page compared these drugs with each other. Written and checked by Jason Hunter; the method is on the editorial standards page.