Characteristics of Cohort with Generalized Myasthenia Gravis in PREDICT Study
Shamik Bhattacharyya1, Sathya Narasimhan2, Danielle Kei Pua1, Yihan Zhang1, Prashanth Rajarajan1, Mattia Wruble1, James Nguyen1, Alice Tang1, Chien-Lin Su3, Michael Blackowicz4, Chloe Sader4, Joome Suh1
1Brigham and Women's Hospital, 2Baylor College of Medicine, 3Worldwide Clinical Trials, 4Alexion Pharmaceuticals
Objective:
To characterize a longitudinal cohort of patients with generalized myasthenia gravis.
Background:
Generalized myasthenia gravis (gMG) is an autoimmune neuromuscular disorder of widely varying clinical severity. The PREDICT study seeks to identify a contemporary cohort of patients with gMG and discover predictors of disease severity.
Design/Methods:
Clinical data extracted from a hospital system (consisting of 12 academic and community hospitals) between 2010-2023. Adults diagnosed with gMG confirmed by neurology with minimum follow-up of one year were included. Demographics, treatment history, and hospitalization history were analyzed.
Results:
406 patients met inclusion criteria with mean follow-up of 7.1 years (SD 6.2). The median age at symptom onset was 64 years (IQR 16, 93) with 40.6% female, 59.4% male; 88.9% White, 4.2% African American, 2.5% Asian. 71.4% with gMG tested positive for acetylcholine receptor antibody with only 5 patients with gMG testing positive for MuSK. At diagnosis, 30 (7.4%) had comorbid autoimmune condition with multiple sclerosis being most common. Median age at MG symptom onset was 60 years (IQR 17, 93) in females compared to 65 years (IQR 16, 92) in males. 34.5% presented initially with ocular MG. 98.3% were treated with non-corticosteroid MG directed therapy of which pyridostigmine was used in 382 (95.7%) followed by azathioprine in 153 (38.3%), mycophenolate mofetil in 145 (36.3%), immunoglobulin injections in 105 (26.9%), rituximab in 27 (6.8%), maintenance plasma exchange in 27 (6.8%), complement inhibitors in 17 (4.3%), and efgartigimod in 11 (2.8%). During follow-up, 139 (34.2%) had a gMG related hospitalization.
Conclusions:
Myasthenia gravis is a disease of older adults with earlier onset by 5 years in females compared to males and with about a third of patients needing hospitalization. Azathioprine and mycophenolate mofetil remain the most used steroid sparing immunomodulatory treatments. Follow up to include additional data on gMG related hospitalization.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.