Interview with Professor, Dr. Geert Jan Groeneveld about myasthenia gravis

Q&A with Dr. Geert Jan Groeneveld, Professor of Clinical Neuropharmacology, Leiden University and Chief Medical and Scientific Officer at the Centre for Human Drug Research in Leiden, The Netherlands

Tell us about your career in neuromuscular diseases and how you became involved in the myasthenia gravis disease space
I have been a neurologist by training since my post-secondary studies. I completed my PhD in Neurology at the Utrecht University Department of Neurology – one of the most esteemed neurology departments in the Netherlands – focusing on amyotrophic lateral sclerosis (ALS). After completing my PhD, and during my residency at the University Medical Center Utrecht, I was not only seeing patients with ALS, but all sorts of patients living with neuromuscular disorders, including patients with myasthenia gravis (MG). Upon finishing my residency, I then relocated to the VU University Medical Center in Amsterdam, now part of the Amsterdam University Medical Center (Amsterdam UMC) where, at the time, I was the only neurologist with a neuromuscular background, so was referred all neuromuscular patients.

In 2017, I left the Amsterdam UMC and moved to the Leiden University Medical Center where I am currently a Professor of Clinical Neuropharmacology in addition to my position as Chief Scientific and Chief Medical Officer at the Centre for Human Drug Research.

What do you see as the biggest challenges in the myasthenia gravis disease space today?
I believe there are currently two significant challenges in the MG space, the first is related to symptomatic treatment and the second related to disease modification. The current, and most common, treatment for symptoms of MG involves the use of cholinesterase inhibitors. These have quite a short half-life which results in the need for more frequent dosing and, if the dose is too high, side-effects are common. The best-case scenario would be that the patient only needs to take one pill a day with minimal to no side-effects. Another solution would be to give something to the patient in conjunction with the cholinesterase inhibitors which could treat the symptoms of MG more effectively.

In the case of disease modification, or targeting the inflammation which occurs in patients with MG, corticosteroids are currently still the mainstay. Corticosteroids work well but cause awful side-effects for patients. What we need here is a therapy that targets the inflammatory process, without the need to use corticosteroids or as low a dose as possible.

What is the significance of these ongoing clinical trials and what are your goals?
The trials that we are conducting with NMD Pharma are significant as there is a strong need for better tools to treat MG; If symptomatic treatment options are improved, the moment at which it is decided to initiate immunosuppressants, which cause nasty side-effects for the patient, may also be delayed or even prevented.

At the moment, there is only one symptomatic treatment for MG – if there existed different varieties of available treatments that work well, or better, on its own or in conjunction with cholinesterase inhibitors, then the quality of life for patients could possibly be greatly improved.

Why do you think it is important to raise awareness of myasthenia gravis through campaigns like Myasthenia Gravis Awareness Month?
Awareness campaigns such as Myasthenia Gravis Awareness Month are important for disease awareness and can really help in fundraising for much needed research. Work that is being done by companies such as NMD Pharma in labs at universities, would not have been possible without the available funding to help them progress. This early academic research is usually then spun-off into companies, like NMD Pharma, which go on to develop the therapies that can hopefully improve the lives of patients.

What are your hopes for the field of research in myasthenia gravis in the next 5-10 years?
The development of targeted anti-inflammatory treatments has been rapidly improving and I believe that this will continue to progress quickly over the next few years. Drugs that are being developed for indications such as psoriasis and Crohn’s may in the future be applicable to MG as well – so I think as a group, the underlying cause of these autoimmune diseases will be much better treated in the next five to 10 years which ultimately means fewer patients will need symptomatic treatment.

Simultaneously though, the development of symptomatic treatments is looking positive and so I’m hoping that we will see new effective treatments emerge that do not cause too many side effects – this would be a huge improvement for patients.

What advice would you give to those affected by myasthenia gravis?
My advice to those that have recently been diagnosed, or those living with MG and are struggling, is to try and visit a specialist in neuromuscular disorders or MG.

Recently, we have seen the emergence of more super-specialists in the medical field, at least that is what we are seeing here in the Netherlands. With these specialists that are focused on treating certain conditions and diseases, patient care has significantly improved and will continue to do so. There are many hospitals globally where MG patients are treated by general neurologists. I believe if they were to be seen by neuromuscular disorder specialists, and hopefully MG specialists, their treatment would most definitely be better.

What other types of neuromuscular diseases are you interested in/working on?
I am also quite interested in the neurodegenerative disease and neuropathic pain spaces. As mentioned previously, I completed my PhD in ALS and so I would say that I am more than averagely interested in ALS.

How did you come across and start working with NMD Pharma?
I have been in touch with the NMD Pharma team for quite some time. We were initially connected via a consultant that both they and the CHDR team had worked with on previous trials, however it was many years later, after our initial connection, until we collaborated on a project together. Since then, we have remained in close contact. The team at NMD has great scientific expertise and we have followed its programs closely including many visits back and forth between Denmark and the Netherlands from both sides. They are a wonderful team to work with and it has been a pleasure to work with them on their study for MG.