Age and Treatment Efficacy in Myasthenia Gravis: A Systematic Review, Meta-Analysis, and Meta-Regression

Area of Science:

• Neurology
• Clinical Trials
• Pharmacology

Background:

• Myasthenia gravis (MG) prevalence is increasing in older adults.
• Age may alter the risk-benefit balance of MG therapies.
• Evaluating age-related treatment efficacy in MG is crucial.

Purpose of the Study:

• To assess the impact of age on treatment efficacy in myasthenia gravis clinical trials.
• To identify if older patient populations experience different treatment outcomes.

Main Methods:

• Systematic literature search of PubMed and Cochrane Library for MG clinical trials.
• Inclusion of trials reporting quantitative myasthenia gravis (QMG) and myasthenia gravis activities of daily living (MG-ADL) scores.
• Random-effects meta-analysis and meta-regression to evaluate treatment effects and age as a modifier.

Main Results:

• Eighteen trials (1823 participants) showed overall treatment benefit for both QMG and MG-ADL scores.
• Meta-regression revealed that older mean trial age attenuated treatment benefit on the QMG score (p=0.047).
• This age-related attenuation was most prominent for FcRn inhibitors; no significant association was found for MG-ADL scores.

Conclusions:

• Older populations in MG trials demonstrated diminished improvements in QMG scores.
• Age appears to influence treatment effects observed in myasthenia gravis clinical trials.
• Findings highlight the need to consider age when interpreting MG treatment efficacy.