2026 American Academy of Neurology Abstract Website

Objective:

To summarize evidence on the effectiveness of Remission (R), minimal manifestations (MM), Slight Improvement (SI), and Patient-Acceptable Symptom State (PASS) as therapeutic goals in Myasthenia Gravis (MG).

Background:

MG is an autoimmune disease characterized by fluctuating weakness. While achieving R or MM is often prioritized, their true impact on patient-centered outcomes remains uncertain.

Design/Methods:

We systematically searched PubMed, Scopus, and CENTRAL (till August 2025) for studies comparing outcomes in MG patients achieving R, MM, SI, or PASS. Random-effects models estimated pooled effects; heterogeneity was assessed with I². Risk of bias was evaluated using the Newcastle-Ottawa scale and certainty with GRADE.

Results:

Nine studies (5 cohort, 4 cross-sectional; 6,165 patients) were included. Compared to R, achieving MM was linked to worse MG-QoL-15 (MD 2.70; 95% CI: 1.61–3.79; I² = 87%), MG-ADL (MD 0.70; 95% CI: 0.19–1.21; I² = 90%), and QMG (MD 2.46; 95% CI: 1.39–3.52; I² = 72%). Versus SI, MM reduced myasthenic crisis risk (OR 0.32; 95% CI: 0.17–0.61) and QMG scores (MD –4.68; 95% CI: –6.36 to –3.00; I² = 91%). Compared to R, SI worsened MG-QoL-15 (MD 6.60; 95% CI: 3.85–9.35; I² = 92%), MG-ADL (MD 3.10; 95% CI: 0.38–5.82; I² = 85%), and QMG (MD 7.36; 95% CI: 6.72–7.99; I² = 0%). Achieving PASS improved MG-QoL-15 (MD –12.18; 95% CI: –18.73 to –5.64; I² = 90%), MG-ADL (MD –4.07; 95% CI: –5.93 to –2.22; I² = 88%), and QMG (MD –6.65; 95% CI: –7.53 to –5.78; I² = 0%). . Risk of bias was low–moderate (cohorts) and moderate–high (cross-sectional). Certainty of evidence was very low across outcomes.

Conclusions:

Achieving MM or R in MG may improve quality of life, function, and symptoms, with very low certainty. MM generally showed worse outcomes than R. PASS appears promising as a treatment goal. Higher-quality studies are needed to confirm these results and guide recommendations.