Objective:

To describe treatment patterns of biologic therapies among newly treated patients with myasthenia gravis (MG). 

Background:

Newer biologic therapies for MG (neonatal fragment crystallizable receptor blockers, C5 complement inhibitors, anti-CD20 therapies) aim to address unmet clinical needs; however, real-world evidence describing treatment patterns of these drugs is limited.

Design/Methods:

Data were drawn from the Merative™ MarketScan® databases from July 1, 2016–September 30, 2024. Continuous enrollment for ≥6 months before and ≥12 months after the earliest date of any MG treatment was required. Treatment patterns were examined among patients who received biologics.  

Results:

Of 2,943 treated patients with MG, 219 had ≥1 claim for a biologic therapy (mean [SD] age, 57.5 [15.1] years; 53.4% male). The mean (SD) time from MG diagnosis to first use of a biologic (biologic index date) was 24.3 (20.9) months. Most patients (98.1%) initiated a biologic as a third- or later-line therapy. The mean (SD) biologic treatment duration was 5.4 (6.9) months, and 65.3% of patients used a biologic in combination with other treatment classes (acetylcholinesterase inhibitors, immunosuppressants, oral glucocorticoids [OG], intravenous immunoglobulin). More patients used OG in the 6 months prior to biologic index date (n=161; 73.5%) than during biologic treatment (n=90; 41.1%). Among patients using biologic therapy with OG, 78.9% (n=71) started on a medium/high OG dose (>5 mg/day prednisone equivalence) at initiation of the biologic, and of those, 38.0% (n=27) moved to low/maintenance dosing (≤5 mg/day prednisone equivalence) during biologic treatment. MG exacerbations and crises were observed in 35.6% and 1.4% of patients during biologic treatment, respectively. 

Conclusions:

Biologic therapies were largely initiated as third- or later-line treatment, with a mean treatment duration of <6 months. Patients continued to experience exacerbations/crises and use OG during biologic treatment. These findings highlight the need for effective biologic therapies earlier in the disease course to improve clinical outcomes.