Objective:

To describe the association between oral corticosteroid (OCS) use and related adverse effects (AEs) among myasthenia gravis (MG) patients.

Background:

MG is a rare disease characterized by autoantibody-driven impairment of neuromuscular junction activity. OCS are included in standard-of-care for MG, with long-term use often necessary for disease control. While OCS use is known to be associated with numerous AEs, there is a gap in understanding the long-term consequences of OCS use among MG patients.

Design/Methods:

This retrospective, longitudinal cohort study leveraged US claims data from Optum’s de-identified Clinformatics® Data Mart Database to identify MG patients (January 2016-March 2023) using diagnoses (ICD-10-CM G70.0x). Patients were divided into cohorts having no OCS use or, after ≥1 month of continuous OCS use post initial MG diagnosis, 0, 1, or 2 6-month periods of continuous exposure to prednisone-equivalent doses ≥5 mg/day during 12-month follow-up. Inverse probability treatment weighting balanced baseline characteristics across cohorts. Weighted prevalence ratios of select AEs (diabetes, fracture, hyperlipidemia, hypertension, infection, myocardial infarction, osteoporosis, stroke) were calculated.

Results:

After weighting, the cohorts with no OCS (n=3297) and 0 (n=418), 1 (n=872), and 2 (n=1243) 6-month periods of continuous OCS use were well-balanced. During follow-up, the 0-, 1-, and 2-period OCS cohorts had significantly increased infection risk relative to the no-OCS cohort: weighted prevalence ratios 1.6 (95% confidence interval [CI]: 1.1-2.1), 1.5 (1.2-2.0), and 1.6 (1.3-2.0), respectively. While osteoporosis risk was similar for the 0-period OCS cohort, the 1- and 2-period OCS cohorts had significantly increased risk relative to the no-OCS cohort: weighted prevalence ratios 1.2 (0.9-1.6), 1.5 (1.2-1.8), and 1.7 (1.4-2.0), respectively.

Conclusions: