Objective:

This study aimed to assess the alignment of global neurology provider practices with the international MG consensus guidelines, identify regional practice trends, and explore the impact of therapy availability.

Background:

International consensus guidelines were established in 2016 and 2020 to standardize myasthenia gravis (MG) management, but their effectiveness across medical providers remains uncertain.

Design/Methods:

An online global survey was distributed to neurology providers, assessing their MG management practices. Respondents were categorized by years of experience, level of training, geographic region, and practice setting. Data were analyzed using descriptive and inferential statistics to evaluate provider characteristics affecting treatment decisions.

Results:

Adult neurologists comprised the majority of respondents (85.2%, 179/210) with 61.4% (129/210) practicing in inpatient settings. Respondents were predominantly from Asia, North America, and Europe. Thymectomy for acetylcholine-receptor-MG was recommended by 53.3% of respondents. Having more than 10 years of experience (OR=2.09, CI=1.14-3.84, p=.017), practicing in developed countries (OR=3.86, CI=1.32-11.31, p=.014), and working primarily in inpatient settings (OR=2.41, CI=1.22-4.75, p=.011) were significantly associated with recommending thymectomy. For MuSK-MG, there was no clear consensus on first-line treatment. In terms of pregnancy and preconception counseling, 61.4% (129/210) recommended discontinuing mycophenolate mofetil (MMF), while 25.2% would continue it at a lower dose, with providers in developed countries more likely to recommend IVIG (OR=2.97, CI=1.07-8.27, p=.038). Regarding mode of delivery, providers in developed countries were more likely to recommend cesarean section (OR=4.86, CI=1.66-14.21, p=.004).

Conclusions:

Despite international consensus guidelines, significant variability exists in MG management practices among neurology providers. Providers with more experience and those in developed countries are more likely to recommend thymectomy and IVIG. Additionally, cesarean section is more frequently recommended in developed countries. These differences highlight the influence of regional cost, surgical availability, and familiarity with therapies. Further research is needed to address these disparities and improve the standardization of MG management globally.