OBJECTIVES: Myasthenia gravis (MG) is a debilitating disease that can substantially impact patients' daily activities, particularly among the subset of patients whose disease is refractory to conventional therapies. These patients live with the burden of a chronic impaired state and also experience a greater frequency of severe clinical events. How this increased burden impacts healthcare resource utilization is not known. Therefore, the objective of this analysis was to compare resource utilization between patients with and without refractory MG. METHODS: The study population was derived from the enrollment survey of the MG Patient Registry (http://www.mgregistry.org/). Patients between 18-65 years of age were studied between July 2013-February 2018 and were required to have an MG diagnosis for at least 2 years prior to survey completion. Patient-reported information, including treatment type, treatment duration and MG-ADL scores, were used to classify patients as having either refractory or non-refractory MG. Healthcare resource use was compared between refractory and non-refractory patients using t-tests and Chi-square tests. RESULTS: This analysis included 76 refractory and 749 non-refractory patients. At enrollment, refractory patients were significantly more likely (in the prior 6 months) than non-refractory patients to have had at least one exacerbation (67.1% vs. 50.2%, p=0.01), five or more clinical exacerbations (13.2% vs. 6.9%, p=0.02), at least one emergency room (ER) visit (43.4% vs. 26.7%, p<0.01), four or more ER visits (7.9% vs. 2.9%, p<0.01), and at least one overnight hospitalization (32.9% vs. 20.3%, p=0.03). Refractory patients were also significantly more likely to have ever been in an intensive care unit (61.8% vs. 32.4% p<0.01) and to have ever needed a feeding tube (21.1% vs. 9.0%, p<0.01). CONCLUSIONS: Refractory patients have distinctly different clinical needs and this added burden is correlated with greater healthcare resource utilization.