Real-World Analysis of Treatment Patterns and Disease Exacerbations Among Patients Initiating Therapy for Myasthenia Gravis
Author(s)
Lesley-Ann Miller-Wilson, PhD, MBA1, Lincy Lal, PharmD, PhD1, Nicole Princic, MS2, Carolyn Ritterson Lew, PhD2, Yuriy Edwards, MD, PhD1, Nicholas Streicher, MD, MPH3.
1Immunovant, Inc., New York, NY, USA, 2Merative, Ann Arbor, MI, USA, 3MedStar Georgetown University Hospital, Washington, DC, USA.
1Immunovant, Inc., New York, NY, USA, 2Merative, Ann Arbor, MI, USA, 3MedStar Georgetown University Hospital, Washington, DC, USA.
OBJECTIVES: This study describes treatment patterns and disease exacerbations among patients initiating treatment for myasthenia gravis (MG), an autoimmune condition characterized by muscle weakness.
METHODS: This retrospective study used the Merative™ MarketScan® Research Databases to identify individuals aged ≥18 years with MG who initiated their first treatment between January 1, 2017 and September 30, 2023 (first treatment claim = index) and had a minimum follow-up of 12 months. Outcomes of interest included the type of index therapy and end reason of 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 acetylcholinesterase inhibitors (ACH), oral glucocorticoids (OG), ACH+OG, systemic immunosuppressants (SYS) with or without intravenous immunoglobulin (IVIG), or targeted therapy with or without 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.
CONCLUSIONS: Results suggest that patients with MG initiate treatment on traditional medications, and that second-line utilization of newer 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.
METHODS: This retrospective study used the Merative™ MarketScan® Research Databases to identify individuals aged ≥18 years with MG who initiated their first treatment between January 1, 2017 and September 30, 2023 (first treatment claim = index) and had a minimum follow-up of 12 months. Outcomes of interest included the type of index therapy and end reason of 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 acetylcholinesterase inhibitors (ACH), oral glucocorticoids (OG), ACH+OG, systemic immunosuppressants (SYS) with or without intravenous immunoglobulin (IVIG), or targeted therapy with or without 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.
CONCLUSIONS: Results suggest that patients with MG initiate treatment on traditional medications, and that second-line utilization of newer 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.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HSD92
Topic
Clinical Outcomes, Health Service Delivery & Process of Care, Real World Data & Information Systems
Disease
Neurological Disorders, No Additional Disease & Conditions/Specialized Treatment Areas