Risk of Exacerbation and Level of Healthcare Resource Utilization in Myasthenia Gravis Assessed by Myasthenia Gravis Activities of Daily Living Score.

introductionLimited data are available on the relationship between myasthenia gravis (MG) severity and MG exacerbations and healthcare resource utilization (HCRU) following exacerbations. The objective of this study was to assess patient characteristics, exacerbation risk in relation to the MG Activities of Daily Living (MG-ADL) score, and HCRU following exacerbation.

methodsThis was a retrospective, cross-sectional, observational study of the patient-reported Myasthenia Gravis Foundation of America Global MG Patient Registry (MGFAPR). Participants were based in the USA, aged ≥ 18 years, had a self-reported MG diagnosis and complete MG-ADL data, and were enrolled between July 1, 2013 and September 30, 2022. Patient demographics, disease characteristics, and HCRU were stratified by MG-ADL score. Negative binomial regression was used to assess the association between MG-ADL score and exacerbation. HCRU for those who had one exacerbation was calculated.

resultsIn total, 3416 patients (2092 [61.2%] females) were eligible; mean (standard deviation) age at diagnosis was 49.4 (17.4) years. Compared with patients in the groups with lower MG-ADL scores (≤ 7), more patients in the higher MG-ADL groups (> 7) were female, younger at the time of MG diagnosis, Black, unemployed, uninsured, had a greater comorbidity burden, and had a shorter disease duration. A positive association between the number of exacerbations and MG-ADL score was observed at enrollment. For each additional point on the MG-ADL score, the rate of exacerbations increased by 13% (incidence rate ratio: 1.13; 95% confidence interval: 1.11-1.15; p < 0.001). At enrollment, 49.6% (n = 386/778) of patients who had one exacerbation had HCRU.

conclusionsWe found socio-demographic disparities in disease severity, a higher comorbidity burden, and an increased MG exacerbation risk with higher MG-ADL scores, with a significant impact of MG exacerbation on HCRU. These results highlight the relationship of MG-ADL score to clinical outcomes and the need for treatment optimization and personalized approaches to MG management, especially in socio-demographic groups with an increased risk of exacerbations.