Srikanth Muppidi, MD, on Evaluating Miv-Cel in Myasthenia Gravis

This interview was originally published on our sister site, NeurologyLive®.

“…I'm optimistic for the field that CAR-T certainly offers a new paradigm of how we would treat refractory antibody-mediated diseases. In many ways, neurology is at the forefront of this development, and I'm excited for the field, for the faculty, and for the patients who are involved in these trials.”

Srikanth Muppidi, MD, a clinical professor of adult neurology at Stanford University, presented findings from the phase 2 KYSA-6 clinical trial (NCT06193889) at the 2026 American Academy of Neurology (AAN) Annual Meeting, held April 18 to 22 in Chicago, Illinois. The trial is evaluating mivocabtagene autoleucel (miv-cel; KYV-101), an investigational fully human antiCD19 chimeric antigen receptor T-cell (CAR-T) therapy, in patients with myasthenia gravis (MG). CGTLive®’s sister site NeurologyLive® sat down with Muppidi on the conference floor to discuss the results in more detail.

In the study, 7 patients received a single dose of miv-cel. Muppidi described the clinical response as robust, with meaningful improvements in clinical symptoms and reductions in MG-Activities of Daily Living (MG-ADL) scores observed across the cohort. From a safety standpoint, the therapy was generally well-tolerated; cytokine release syndrome (CRS) was limited to low-grade events, and neither high-grade CRS nor immune effector cell–associated neurotoxicity syndrome was reported in any participant. Muppidi also described several mechanistic observations from the phase 2 data, including CAR T-cell expansion, depletion of B-cells, and decreases in pathogenic autoantibody titers. Of particular note, protective antibody responses—including those directed against viral pathogens and vaccination-related antigens—appeared to be preserved, a finding that raises the possibility of a selective immune reset rather than generalized immunosuppression. Muppidi was measured in his interpretation of this finding, emphasizing that confirmation through further study will be necessary before firm conclusions can be drawn.

With regard to unanswered questions, Muppidi identified durability of response as the most pressing unknown, expressing cautious optimism that benefit may be sustained for at least 1 to 2 years, if not longer. He also noted the absence of comparative data across different CAR-T targets currently under investigation in autoimmune disease, as well as the need for long-term safety follow-up given the recency of this therapeutic approach in nononcologic indications. Looking ahead, Muppidi described plans for a phase 3 randomized trial of miv-cel in MG in which patients will be assigned to miv-cel or continued standard of care, with the option to cross over to miv-cel after 6 months.