Real-world Treatment Patterns Among Patients with Generalized Myasthenia Gravis in the United States

Conventional treatments for generalized myasthenia gravis (gMG) include acetylcholinesterase inhibitors (AChEi), systemic corticosteroids, and non-steroidal immunosuppressants; standard of care for exacerbation or myasthenic crisis includes immunoglobulin and plasmapheresis; newer advanced treatments include B-cell depleting agents, complement-5 inhibitors (C5i), and neonatal Fc receptor (FcRn) blockers. This study described real-world treatment patterns with currently available therapies and prevalence of myasthenia gravis (MG)-related clinical events (exacerbations or crises) among patients with gMG in the US.

Adults with gMG were identified from Komodo Research Data (January 1, 2017-February 28, 2025). Index date was the first MG diagnosis by a neurologist. Patients were followed for ≥ 12 months post-index. Treatment sequencing was characterized by individual classes and broader treatment types (conventional treatments, advanced immunotherapies, immunoglobulin). A treatment episode was defined based on treatment changes (discontinuation, switch, augmentation/add-on, or drop), with any remaining or newly initiated/added treatment marking a new episode. Prevalence of MG-related clinical events was also described.

A total of 8759 patients were included (mean age: 61.5 years; 48.7% female; mean follow-up: 36.5 months). From the first (n = 7986) to fifth (n = 3340) treatment episode, AChEi use declined (80.3→57.6%), systemic corticosteroid use was consistent (49.0→63.0%), and use increased for non-steroidal immunosuppressants (12.7→40.2%), immunoglobulin (6.1→14.5%), rituximab (0.3→2.1%), C5i (0.3→3.4%), and FcRn blockers (0.3→3.8%). Conventional treatments were most frequently used in all episodes; advanced treatment use increased progressively from the first to fifth episodes, with initiation averaging 13.6-19.0 months post-diagnosis. Overall, 48.6% of patients experienced MG-related clinical events during follow-up, usually within the first year following gMG diagnosis (39.9%).

Conventional treatments were the predominant initial strategy for gMG, while immunoglobulin and advanced treatments became more common over successive treatment episodes. The high prevalence of MG-related clinical events within the first year post-gMG diagnosis, despite treatment with conventional therapies, suggests the need for more effective and earlier interventions.