Skip to content
DraconiticResearch
Search Sources API
197,578 studies31 sourcesUpdated 26 min ago
Peer-reviewedCC BY 4.0Frontiers in Neurology

Exacerbations and crises in generalized myasthenia gravis: predictors and associated economic burden in the United States

  • Kavita Grover1,2
  • Martin Cloutier3
  • Geoffroy Coteur4,5
  • Porpong Boonmak3
  • Antoine C. El Khoury4
  • Maryia Zhdanava3
  • Anabelle Tardif-Samson3
  • Yuxi Wang3
  • Kavita Gandhi4
5 affiliations
  1. 1Henry Ford Health System
  2. 2Wayne State University School of Medicine
  3. 3Analysis Group, Inc.
  4. 4Johnson and Johnson
  5. 5iPATH Solutions, BV
Read full textPDFDOICite

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.

Methods: 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.

Results: 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.

Discussion: 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.

Related

  1. Commentary: Efgartigimod for generalized myasthenia gravis: a comprehensive review of clinical evidence and future perspectives
    Ana Belén Fernández
    Frontiers in NeurologyPeer-reviewedCC BY 4.0Full textNeurologyCrossrefPMC
  2. Clinical events and health care costs among pediatric and young adult patients with generalized myasthenia gravis in the United States
    Jacqueline Pesa, Zhiwen Liu, Louis Jackson +1
    Journal of Managed Care & Specialty PharmacyPeer-reviewedLicence not statedFull textNeurologyPMC
  3. Individualized sequencing of targeted immunotherapies in generalized myasthenia gravis across distinct patient profiles
    Vasiliki Zouvelou, Dimitra Tzavella, Eleni Strataki +1
    Frontiers in NeurologyPeer-reviewedCC BY 4.0Full textNeurologyCrossrefEurope PMCPMC
  4. The effect of FcRn inhibition on overlapping autoimmune comorbidity in AChR-seropositive generalized myasthenia gravis.
    Vincenzo Di Stefano, Nicasio Rini, Sofia Campo +10
    Frontiers in neurologyPeer-reviewedCC BYFull textNeurologyEurope PMCCrossref
  5. Clinical study of eculizumab with or with not tacrolimus in the treatment of generalized myasthenia gravis
    Bin Yang, Jing Wang, Xiuli Zhao +3
    Frontiers in ImmunologyPeer-reviewedCC BY 4.0Full textNeurologyCrossrefEurope PMC

Cite

BibTeXRIS
BibTeX
@article{grover2026exacerbations,
  title = {{Exacerbations and crises in generalized myasthenia gravis: predictors and associated economic burden in the United States}},
  author = {Kavita Grover and Martin Cloutier and Geoffroy Coteur and Porpong Boonmak and Antoine C. El Khoury and Maryia Zhdanava and Anabelle Tardif-Samson and Yuxi Wang and Kavita Gandhi},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1919726},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1919726/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Exacerbations and crises in generalized myasthenia gravis: predictors and associated economic burden in the United States
AU  - Kavita Grover
AU  - Martin Cloutier
AU  - Geoffroy Coteur
AU  - Porpong Boonmak
AU  - Antoine C. El Khoury
AU  - Maryia Zhdanava
AU  - Anabelle Tardif-Samson
AU  - Yuxi Wang
AU  - Kavita Gandhi
PY  - 2026
DA  - 2026/10/19
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1919726
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1919726/full
AB  - 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.  Methods: 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.  Results: 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.  Discussion: 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.
SN  - 1664-2295
ER  -