2026 American Academy of Neurology Abstract Website

Elena Faedo¹, Sarah Souvannanorath², Thierry Gendre³, Fatima Ikheteah², Alice Dormeuil³, Valentine Perrain³, Gianmarco Severa⁴, Iman Tahiri², Alban Gravier³, Tarik Nordine³, Violaine Planté-Bordeneuve³, Jean-Pascal Lefaucheur³, Alain Créange³, François-Jérôme Authier⁴, Edoardo Malfatti⁴
¹Reference Center for Neuromuscular Disorders, APHP Henri Mondor University Hospital, Créteil, France and Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genova, Italy, ²Reference Center for Neuromuscular Disorders, APHP Henri Mondor University Hospital, Créteil, France, ³Department of Neurology, APHP Henri Mondor University Hospital, Créteil, France, ⁴University Paris Est Créteil, Inserm, U955, IMRB, F-94010 Créteil, France

Objective:

This retrospective cohort study aimed to delineate disease trajectories, antibody subtypes, and long-term outcomes in a large French Myasthenia gravis (MG) cohort.

Background:

MG is a heterogeneous autoimmune disorder with variable phenotypes and outcomes. Real-world studies are still scarce, especially regarding the trajectories of generalized, ocular, and seronegative cases in the era of new targeted therapies.

Design/Methods:

We retrospectively analyzed 119 MG patients followed over 18 year at the Mondor University Hospital neuromuscular reference center. Demographics, clinical, antibody status, thymic pathology, treatment patterns, and long-term outcome were collected. Outcomes included generalization, relapse, remission, and mortality. Kaplan-Meier, Cox regression, and logistic regression identified predictors.

Results:

The cohort included 77% (N= 92) anti-AChR, 5% (N=6) anti-MuSK, and 17.6% (N=21) seronegative patients. Generalized MG accounted 76% (N=90) , ocular MG 24% (N=29). Relapses occurred in 72% (N=86). About half of ocular MG later generalized, often after two years, with higher generalization risk in female and late-onset MG. Severity at diagnosis and of the first relapse independently predicted long-term burden. Remission (MGFA 0–I) was achieved in 42% (N=50), more frequently in ocular and relapses-free patients. Seronegative patients had longer relapse-free intervals and a higher proportion of sustained ocular disease. At last follow-up, 31% (N=37) used anticholinesterase monotherapy, 62% (N=74) received corticosteroids (45% discontinued, N=33), and 80% (N=95) received azathioprine or mycophenolate. Rituximab, FcRn and complement inhibitors were used in 15% (N=18). Mortality was comparable to the general population.

Conclusions:

Early disease severity and occurrence of the first relapse were strong predictors of long-term outcomes in MG, underscoring the importance of early, risk-adapted management. Ongoing vigilance for generalization remains essential, particularly in ocular-onset and elderly-onset cases. In this real-world cohort, both conventional therapies and newer agents targeting FcRn or complement pathways were associated with high remission rates and facilitated corticosteroid tapering.