Longitudinal treatment patterns in myasthenia gravis: An analysis from the prospective Dutch-Belgian patient registry

Understanding treatment patterns in myasthenia gravis (MG) is crucial for clinical practice. However, longitudinal data are limited.

This study aimed to provide an overview of treatment patterns in different subgroups throughout the disease course.

All adult patients with acetylcholine receptor (AChR), muscle-specific kinase (MuSK), or seronegative MG enrolled in the Dutch-Belgian myasthenia registry were included. AChR-MG patients were classified into early-onset (EOMG) (≤50 years) and late-onset (LOMG) (>50 years) MG. Mixed-effects regression was used to compare differences between the different subgroups.

A total of 506 patients were included (147 AChR EOMG, 265 AChR LOMG, 26 MuSK, and 94 seronegative MG patients). Data were available within a year of diagnosis for 84 patients. Most patients initially started treatment with pyridostigmine (93%; 78/84), followed by corticosteroids (52%; 44/84) and azathioprine or mycophenolate mofetil (30%; 25/84). After ten years, the use of pyridostigmine (65%; 54/83) and corticosteroid use (36%; 30/83) declined, whereas the use of azathioprine and mycophenolate mofetil increased (55%; 46/83). Seronegative patients received fewer treatments than AChR MG patients, independent of functional status and disease duration (OR 0.38, 95% CI 0.17-0.84, p = 0.018), and were less likely to use corticosteroids (OR 0.15, 95% CI [0.05-0.41], p < 0.001). Patients with LOMG reported more frequently immunosuppressive use compared to patients with EOMG (OR 4.69, 95% CI 1.16-19.02, p = 0.031).

This analysis offers valuable insights into treatment patterns in different subgroups of patients with MG. A substantial proportion of patients continues to rely on corticosteroids, suggesting an ongoing need for alternative treatment options.