Identifying Risk Factors for Exacerbation and Symptom Worsening—A Retrospective Cohort Study of Patients with Myasthenia Gravis in the United States
Zia Choudhry1, Minjee Park2, Pushpa Narayanaswami3, Nizar Souayah4, Raghav Govindarajan5, Michael Kutch6, Amaia Zurinaga Gutierrez2, Aurélie Chekroun Martinot2, Nolan Campbell1, Richard Nowak7
1Janssen Scientific Affairs, LLC, a Johnson & Johnson Company, 2Alira Health, 3Beth Israel Deaconess Medical Center, 4NJMS, 5HSHS St. Elizabeth Medical Group, 6Cytel Inc, 7Yale University School of Medicine
Objective:
To identify baseline (enrollment) risk-factors for ≥1 self-reported exacerbation(s) in the past 6-months at first follow-up, and for a myasthenia gravis (MG) activities-of-daily-living (MG-ADL) score ≥2 point increase between baseline and first follow-up.
Background:
The MG Foundation of America Global MG Patient Registry (MGFAPR) captures longitudinal patient-reported data that may facilitate understanding risk factors associated with MG.
Design/Methods:
This retrospective cohort study analyzed 1319 MGFAPR surveys completed between July 2013–June 2023 by US-based adults with self-reported MG and first follow-up data available within 12 months of enrollment. Exacerbations in the past 6-months and changes in MG-ADL scores at first follow-up were evaluated. Univariate analyses and multivariate logistic regressions were conducted.
Results:
Of 1319 patients assessed, 1187 (90%) reported the presence/absence of exacerbation(s); 460 (39%) reported ≥1 exacerbation. At first follow-up, identified factors positively associated (p<0.05) with a report of experiencing ≥1 exacerbation(s) in the previous 6-months were comorbid anxiety/depression (2x more likely), living alone (74%+), corticosteroids (36%+), and MG-ADL score point-increase (19%+ per-point) at enrollment. Factors inversely associated (p<0.05) with ≥1 exacerbation(s) included ocular versus generalized first MG symptoms (51%-), nonsteroidal immunosuppressants at enrollment (25%-), and each additional year post-diagnosis (2%-). Overall, 1232 (93%) patients reported MG-ADL scores at enrollment and first follow-up; 210 (17%) had ≥2 point increase in MG-ADL score. Factors positively associated (p<0.05) with MG-ADL score increase ≥2 included first MG-symptoms as generalized vs ocular (~138%+) and comorbid anxiety/depression (73%+). Factors inversely associated (p<0.05) with MG-ADL ≥2 point increase were plasma exchange (excluding rescue therapy; 83%-), physical activity at enrollment (37%-), and increased age at first follow-up (2%-/year).
Conclusions:
Findings from this MGFAPR-based analysis suggest many US individuals with MG reported uncontrolled disease despite available treatment options. Important risk factors identified for exacerbation or symptom worsening included living alone, generalized MG symptomology, and comorbid anxiety/depression.
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