A Retrospective Claims Database Analysis of Patterns of Steroid Use and Treatment Burden in US Patients With Generalized Myasthenia Gravis


Clinical Trials

Poster Number: M260


Nicholas Sylvestri, MD, FAAN, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Justin Lee, Alexion, AstraZeneca Rare Disease, Karen Yee, Alexion, AstraZeneca Rare Disease, Michael Blackowicz, Alexion, AstraZeneca Rare Disease, Ema Rodriguez, Alexion, AstraZeneca Rare Disease, Ashley Yegin, Alexion, AstraZeneca Rare Disease

Background: Generalized myasthenia gravis (gMG) treatment options include nonspecific immunosuppression with corticosteroids, which are associated with adverse effects, particularly with high-dose, long-term use and in patients with comorbidities.Objective: Quantify the burden associated with high-dose, long-term corticosteroid usage in patients with gMG.Methods: The IQVIA PharMetrics® Plus claims database (1/1/2006-6/30/2022) was retrospectively analyzed. Eligible patients were aged ≥18 years, had ≥2 claims (≥30 days apart) with MG diagnosis ICD9 or ICD10 codes filed via non-ophthalmologic specialist as primary, and continuously enrolled during 6 months before and 24-month follow-up after first MG claim. Outcomes included prednisone daily dose and number of treated days, incidence rates of gMG crisis and exacerbation, and prevalence of comorbidities among propensity score-matched patients.Results: Of 10,816 eligible patients, 49% were male, mean (95% CI) age was 57.8 (57.5-58.1) years, 76% had commercial insurance, 23% Medicare, and 1% Medicaid. Of the 4566 patients with any corticosteroid use, 59% (2684/4566) had long-term (>90 days) treatment courses; the majority (n=4099) with corticosteroid use were treated with prednisone. Among patients who received prednisone, 76% (2033/2677) with long-term use received >10 mg/day and had a mean dose of 21.3 (20.8-21.9) mg/day. Prevalence of cardiovascular disease, gastrointestinal disorder, hypertension, obesity, osteoporosis, and type 2 diabetes was significantly greater among patients treated with long-term corticosteroids than those without corticosteroid use (P≤0.05). Incidence rates of MG inpatient exacerbations were 20.8 and 6.2 per 100 patient-years among patients with long-term use and no corticosteroid use, respectively; incidence of MG crises were 7.0 and 3.0 per 100 patient-years, respectively.Conclusions: This analysis of US claims data illustrates the large burden of high-dose, long-term corticosteroid use in patients with gMG and the high burden of comorbidities. These findings emphasize the importance of considering potentially steroid-sparing, novel treatment options with more tolerable safety profiles, such as complement inhibitors.