Treatment and clinical research in myasthenia gravis (MG) have had major advances during the past 60 years. The 1930s saw the initial era of acetylcholinesterase inhibitors due to the work of Mary Walker (Walker, 1934). At the end of the 1930s, Blalock initiated the era of thymectomy for MG (Kaminski et al., 2024; Narayanaswami et al., 2021; Sanders et al., 2016; Schumacher & Roth, 1912). Glucocorticoids (GCC) and plasmapheresis (PLEX) (Howard et al., 1976; Pinching et al., 1977) were introduced in 1970s and 1970s. Throughout the next several decades, several drugs were introduced to suppress the immune system. The first of these drugs was azathioprine (AZA), followed by cyclosporine (CSA) and then mycophenolate mofetil (MMF) (Benatar & Rowland, 2008; Chaudhry et al., 2001; Ciafaloni et al., 2001; Group, 2008; Hehir et al., 2010; Meriggioli, Ciafaloni, et al., 2003; Palace et al., 1998; Sanders & Siddiqi, 2008; Tindall et al., 1987, Tindall et al., 1993). In the 1980s and 1990s, intravenous immunoglobulin (IVIg) began being used in MG patients (Alcantara et al., 2021; Arsura, 1989; Fateh-Moghadam et al., 1984; Gajdos et al., 1997; Wolfe et al., 2002).

It should be noted that all immunosuppressive and immunomodulating therapies were originally introduced for reasons other than to treat MG. The general care provided by intensive care units such as mechanical ventilation and the antibiotic therapy, made a big contribution to the prognosis of MG patients. Due to a combination of all the new therapeutic advances, mortality from MG has dropped significantly during the past 50 years. Prior to 1960, the mortality from MG was estimated to be more than 30 %. Now most experts consider the mortality rate from MG to be less than five percent (Grob et al., 2008).

We now expect most patients to improve, and some to go into remission. While the costs of older medications, such as prednisone, remain relatively modest, as newer medications become available, the costs are increasing. Economic resources are determining factors in the choice of therapeutic regimen in low-income countries.