Functional Improvement in Patients With Myasthenia Gravis Following GLP-1/GIP Receptor Agonist Therapy: A Case Series
Claudia Guerra Hernandez1, Jerrica Farias1, Kathleen Murray1, I-Hweii Chen1, Clifton Gooch1, Tuan Vu1
1University of South Florida
Objective:
To describe improvement in functional status in three overweight patients with generalized Myasthenia Gravis (gMG) treated with glucagon-like peptide-1/glucose-dependent insulinotropic polypeptide dual receptor agonists (GLP-1/GIP RA).
Background:
Patients with gMG are often overweight due to pre-existing comorbidity, corticosteroid use, and exercise intolerance. Obesity causes systemic inflammation that may contribute to worsened disease activity and fatigue via increased muscle work-load and predisposition to sleep apnea. GLP-1/GIP RA can augment weight loss and reduce markers of inflammation in other disease states, but their impact on gMG outcomes has not been reported.
Design/Methods:
We retrospectively evaluated changes in weight, BMI, and functional status, as measured by the Myasthenia Gravis Activities of Daily Living (MG-ADL) scale, in three patients with gMG treated with GLP-1/GIP RA for metabolic indications between 2023-2025.
Results:
Case 1: 62-year-old man stable on ravulizumab and pyridostigmine lost 44 lb (BMI 40 to 33.7) after GLP-1/GIP RA with net improvement in MG-ADL from 5 to 3 over one year.
Case 2: 71-year-old woman stable on efgartigimod, mycophenolate, and pyridostigmine lost 28 lb (BMI 47.5 to 42.5) after GLP-1/GIP RA and had consistent MG-ADL improvement from 5 to 2 over two years.
Case 3: 50-year-old woman on pyridostigmine and prednisone 20mg daily lost 40 lb (BMI 29.3 to 21.9) after GLP-1/GIP RA over one year. MG-ADL fluctuated as patient tapered off prednisone, but was stable at one year. This finding was complicated by the addition of mycophenolate.
All patients reported reduced fatigue, more exertion tolerance, and improved well-being with weight loss that preceded improvement in gMG outcomes.
Conclusions:
In this small series, treatment with GLP-1/GIP RA was associated with weight loss and subjective functional improvement that did not consistently correlate with immediate change in MG-ADL. Larger controlled studies that also include broader health outcomes are needed to investigate potential mechanism of benefit and impact on gMG.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.