Symptomatic therapy of (highly) active MG, including ‘refractory to therapy’, should be supplemented by the following disease-modifying therapies: In AChR-Ab-positive status, complement inhibitors (eculizumab, ravulizumab) or FcRn modulators (efgartigimod) ± thymectomy should be selected. The gene discussed is FCGRT; the disease is myasthenia gravis.