Objective:

To describe real-world treatment patterns, discontinuation, and treatment switching among a prevalent cohort of patients with generalized myasthenia gravis (gMG) in the United States.

Background:

gMG is a chronic autoimmune disorder associated with fluctuating muscle weakness. Understanding treatment patterns, including steroid use and therapy switching, is essential to identify unmet needs in clinical practice.

Design/Methods:

This retrospective cohort study used administrative claims from the MORE2 Registry® and Medicare Fee-for-Service (2018–2024). Eligible patients were ≥18 years old with ≥1 inpatient or ≥2 outpatient claims for gMG and ≥12 months of continuous enrollment before and after index; ocular MG was excluded. Outcomes assessed included treatment patterns during the variable-length follow-up period.

Results:

Among 44,525 patients with prevalent gMG, oral corticosteroids (48%) were the most common therapy, followed by non-steroidal IST (25%). Biologic use was low (6%), with rituximab, eculizumab, and efgartigimod most frequently prescribed. Monotherapy predominated (57%), while 16% received combination regimens. Prednisone-equivalent dosing showed substantial exposure: 22% received ≥20 mg/day, 17% 10–<20 mg/day, 7% 5–<10 mg/day, and 2% >0–≤5 mg/day. The mean duration of the first treatment was 292 days. Regimen termination most often reflected discontinuation (61%), followed by stacking/add-on therapy (15%) and switching (9%). Notably, 35% of patients had treatment sequences that involved repeated courses of steroids separated by ≥60-day gaps. Illustrating how discontinuation often represented cycling back to corticosteroids rather than durable regimen change. These patterns highlight frequent interruptions in care, recurrent steroid cycling, and limited progression to biologics, consistent with payer-driven step therapy and barriers to biologic initiation.

Conclusions:

In this large real-world cohort, treatment of gMG remains dominated by steroids, with low biologic uptake and frequent discontinuation. High reliance on corticosteroid monotherapy and repeated cycling highlight persistent unmet need in managing gMG, underscoring the importance of expanding access to effective targeted therapies.