Neurologists’ Therapeutic Inertia in the Management of Generalized Myasthenia Gravis
Gerardo Gutiérrez-Gutiérrez1, Rocío Gómez2, Javier Sotoca Fernandez3, Adrián Arés4, Ramón Villaverde5, Virginia Reyes6, Thaís Armangué7, Luis Querol8, Elisa Salas Alonso2, Paola Díaz-Abos2, Jorge Maurino2, Elena Cortes-Vicente8
1Department of Neurology, Hospital Universitario Infanta Sofía, 2Medical Department, Roche Farma, 3Department of Neurology, Hospital Universitario Vall d’Hebron, 4Department of Neurology, Complejo Asistencial Universitario León, León, 5Department of Neurology, Hospital Universitario Morales Meseguer, 6Department of Neurology, Hospital Regional Universitario de Málaga, 7Department of Pediatric Neuroimmunology, Hospital Sant Joan de Déu, 8Department of Neurology, Hospital de la Santa Creu i Sant Pau
Objective:
The study aim was to assess neurologists’ therapeutic inertia (TI) in generalized Myasthenia Gravis (gMG).
Background:
Limited information is available on how neurologists make therapeutic decisions in gMG, especially now that new treatments with different mechanisms of action, administration, and safety profiles are approved.
Design/Methods:
An online, cross-sectional study was conducted in collaboration with the Spanish Society of Neurology in April-July, 2024. Neurologists answered a survey of demographic characteristics, professional background, behavioral traits, and simulated case scenarios. TI score was defined as the number of simulated case scenarios that resulted in a lack of initiation/intensification to more efficacious treatments when therapeutic goals were unmet [meaning an increase in Myasthenia Gravis Activities of Daily Living (MG-ADL) scale of at least 1 point]. Scenarios included: four treated class IIa/IIb patients with limb/bulbar symptom worsening, one naïve patient, one rapidly progressing patient, and one with ocular symptom worsening. Relationships between TI presence and neurologists’ characteristics were assessed through Chi square test and Mann-Whitney U test.
Results:
A total of 149 neurologists were included (mean age [SD]: 39.0±9.4 years, 54.3% male, median experience managing gMG [IQR]: 7 [3-15] years; 32.2% fully dedicated to gMG). Median gMG patients attended per month was 10 (IQR: 5-20). A proportion of 34.9% participants reported using minimum symptom expression to guide treatment decisions.
Overall, 79.9% of participants (n=119/149) presented TI in at least 2 out of 7 scenarios. The mean (SD) TI score was 3.7 (2.1). Lower perceived ease of use of new targeted treatments, lower organizational support for the introduction of these new therapies, and higher overall resistance to change behavior were related to TI presence.
Conclusions:
TI managing gMG is a common phenomenon in this new treatment context. Identifying it and implementing specific intervention strategies may be critical to avoid suboptimal treatment decisions and improve patient care.
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