Background: Myasthenia gravis (MG) is an autoimmune disease impacting neuromuscular transmission, resulting in weakness. Traditional treatments include acetylcholinesterase inhibitors (ACH), systemic immunosuppressants (SYS), and oral glucocorticoids (OG); however, newer targeted treatments are entering the market.
Objectives: To describe treatment patterns and disease exacerbations among patients initiating treatment for MG.
Methods: This retrospective study used the Merative™ MarketScan® Research Databases to identify individuals aged ≥18 years with MG who initiated their first (index) treatment between January 1, 2017 and September 30, 2023 and had ≥12 months’ follow-up. Outcomes of interest included type of index therapy, end reason for the index line (ie, switch/add medications, discontinuation, censoring [disenrollment/study end]), second-line treatments, exacerbations (defined by treatment for flares or MG-related hospitalizations), and steroid use.
Results: The analysis included 2,943 patients initiating MG treatment (mean [SD] age, 58.1 [15.7] years; 52.4% female) with a mean (SD) follow-up of 37.2 (21.4) months. Overall, 44.9%, 32.6%, 15.3%, 7.0%, and 0.2% initiated treatment with ACH, OG, ACH+OG, SYS +/- intravenous immunoglobulin (IVIG), or targeted therapy +/- IVIG, respectively. During follow-up, 54.0% of patients discontinued index treatment (59.2% of whom restarted), 34.7% switched or added another medication prior to discontinuation, and 11.3% were censored. Among patients initiating second-line treatment (n =1,962), OG were the most commonly used (50.7%), followed by ACH (26.9%), SYS (15.3%), IVIG (4.5%), and targeted therapies (2.7%). Exacerbations occurred in 16.6% of patients during the follow-up period (2.2 per patient per year). Steroid use was evident in 79.0% of patients, with 65.2% having an average daily dose >15 mg prednisone equivalent.
Conclusion: Results suggest that patients with MG initiate treatment with traditional medications, and that second-line utilization of targeted therapies remains low despite evidence of poor disease control. These findings highlight the need to explore additional or alternative treatment strategies to achieve and sustain improvement.