{
  "abstract": "Introduction: The management of exacerbations and crises (clinical events) in generalized myasthenia gravis (gMG) patients is resource-intensive. Identifying characteristics associated with increased risk for these events may help optimize allocation of preventative strategies. This study identified baseline predictors of a first clinical event following diagnosis and assessed the burden of these events among patients with gMG in the United States.\n\nMethods: A newly diagnosed cohort of adults with gMG were identified from Komodo Research Database (01/2017–09/2023) with an index date at the first gMG diagnosis made by a neurologist. Baseline demographics, comorbidities, gMG-related treatments, healthcare resource utilization (HRU) and costs were described; patients were followed until first clinical event or censoring at end of follow-up. A multivariable Cox proportional hazards model assessed baseline predictors of the first clinical event. Among patients with ≥12 months of follow-up, cohorts with and without a clinical event during follow-up were created; index date was the first clinical event or a random date, respectively. Cohorts were re-weighted using entropy balancing. HRU and costs during 12 months post-index were compared.\n\nResults: Among 6,195 patients with gMG (mean age: 61.1 years; female: 49.1%), higher event risk was associated with use of immunoglobulin [hazard ratio (HR) = 1.54], baseline dysarthria (HR = 1.45), general and other muscle-specific weaknesses (HR = 1.38), use of non-steroidal immunosuppressants (HR = 1.37), dysphagia (HR = 1.28), weight loss (HR=1.27), dyspnea (HR = 1.23), ptosis (HR = 1.20), absence of other autoimmune disorders (HR=1.18), and male sex (HR = 1.15; all p < 0.05). In the cohort, 2,657 had a clinical event, while 3,092 did not; all had ≥12 months of follow-up after index. After re-weighting, patients with a clinical event had higher number of inpatient admissions [rate ratio (RR) = 6.02], emergency visits (RR = 1.91), and outpatient visits (RR = 1.58; all p < 0.05) in the 12 months post-index. Mean total healthcare costs were $70,792 higher among patients with a clinical event ($95,821 vs. $25,029, p < 0.001), driven by immunoglobulin and inpatient costs.\n\nDiscussion: Disease severity and immunosuppressive therapy use were associated with increased risk of exacerbations and crises, which imposed substantial HRU and cost burden. Findings may help identify candidates who could benefit from earlier or more advanced therapies to prevent acute clinical events.",
  "abstract_shown": true,
  "affiliations": [
    "Henry Ford Health System",
    "Wayne State University School of Medicine",
    "Analysis Group, Inc.",
    "Johnson and Johnson",
    "iPATH Solutions, BV"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Kavita Grover"
    },
    {
      "affs": [
        2
      ],
      "name": "Martin Cloutier"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Geoffroy Coteur"
    },
    {
      "affs": [
        2
      ],
      "name": "Porpong Boonmak"
    },
    {
      "affs": [
        3
      ],
      "name": "Antoine C. El Khoury"
    },
    {
      "affs": [
        2
      ],
      "name": "Maryia Zhdanava"
    },
    {
      "affs": [
        2
      ],
      "name": "Anabelle Tardif-Samson"
    },
    {
      "affs": [
        2
      ],
      "name": "Yuxi Wang"
    },
    {
      "affs": [
        3
      ],
      "name": "Kavita Gandhi"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/b99befz51dj8j.bib",
  "cited_by": 0,
  "doi": "10.3389/fneur.2026.1919726",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13724412/?tool=EBI",
  "id": "b99befz51dj8j",
  "issns": [
    "1664-2295"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fneur.2026.1919726/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2728|Myasthenia Gravis and Thymoma"
    ]
  ],
  "openalex": "W7222965587",
  "pdf_url": "https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2026.1919726/pdf",
  "pmcid": "PMC13724412",
  "pmid": "42973500",
  "published": "2026-10-19",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/b99befz51dj8j.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:16Z",
      "native_id": "10.3389/fneur.2026.1919726",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fneur.2026.1919726/full"
    },
    {
      "first_seen": "2026-11-03T15:20:51Z",
      "native_id": "PMC:PMC13724412",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13724412"
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      "url": "https://doi.org/10.3389/fneur.2026.1919726"
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    {
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    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2728|Myasthenia Gravis and Thymoma",
      "subfield": "neurology"
    }
  ],
  "title": "Exacerbations and crises in generalized myasthenia gravis: predictors and associated economic burden in the United States",
  "title_text": "Exacerbations and crises in generalized myasthenia gravis: predictors and associated economic burden in the United States",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:20:54Z",
  "url": "https://research.draconitic.com/paper/b99befz51dj8j",
  "venue": "Frontiers in Neurology",
  "versions": []
}