Late-Onset Myasthenia Gravis: An Increasingly Frequent Clinical Entity With Distinctive Challenges

Late-onset myasthenia gravis (LOMG) is defined as myasthenia gravis (MG) with symptom onset after the age of 50 years, while patients manifesting after 65 years of age have been categorized as very-late-onset MG (VLOMG). LOMG represents the most prevalent MG subgroup. Clinically, LOMG is characterized by a slight male predominance that becomes more pronounced with advancing age, a frequent oculo-bulbar presentation at onset, and a higher incidence of potentially life-threatening events at disease onset. Nonetheless, it is generally associated with a favorable prognosis, including a relatively high rate of spontaneous remission in VLOMG. The shifting epidemiological landscape of MG, marked by a notable increase in LOMG diagnoses, raises critical questions regarding the adequacy of current therapeutic approaches and whether a distinct therapeutic approach is warranted. Crucial gaps in evidence requiring further investigation include the clinical efficacy of thymectomy, as well as the optimal selection, dosing, and management of immunosuppressive agents and emerging targeted therapies in older patients.