Real-world Treatment Patterns Among Patients with Generalized Myasthenia Gravis in the United States

Conventional treatments for generalized myasthenia gravis (gMG) include acetylcholinesterase inhibitors (AChEi), systemic corticosteroids, and non-steroidal immunosuppressants; standard of care for exacerbation or myasthenic crisis includes immunoglobulin and plasmapheresis; newer advanced treatments include B-cell depleting agents, complement-5 inhibitors (C5i), and neonatal Fc receptor (FcRn) blockers. This study described real-world treatment patterns with currently available therapies and prevalence of myasthenia gravis (MG)-related clinical events (exacerbations or crises) among patients with gMG in the US. Adults with gMG were identified from Komodo Research Data (January 1, 2017–February 28, 2025). Index date was the first MG diagnosis by a neurologist. Patients were followed for ≥ 12 months post-index. Treatment sequencing was characterized by individual classes and broader treatment types (conventional treatments, advanced immunotherapies, immunoglobulin). A treatment episode was defined based on treatment changes (discontinuation, switch, augmentation/add-on, or drop), with any remaining or newly initiated/added treatment marking a new episode. Prevalence of MG-related clinical events was also described. A total of 8759 patients were included (mean age: 61.5 years; 48.7% female; mean follow-up: 36.5 months). From the first ( n = 7986) to fifth ( n = 3340) treatment episode, AChEi use declined (80.3→57.6%), systemic corticosteroid use was consistent (49.0→63.0%), and use increased for non-steroidal immunosuppressants (12.7→40.2%), immunoglobulin (6.1→14.5%), rituximab (0.3→2.1%), C5i (0.3→3.4%), and FcRn blockers (0.3→3.8%). Conventional treatments were most frequently used in all episodes; advanced treatment use increased progressively from the first to fifth episodes, with initiation averaging 13.6–19.0 months post-diagnosis. Overall, 48.6% of patients experienced MG-related clinical events during follow-up, usually within the first year following gMG diagnosis (39.9%). Conventional treatments were the predominant initial strategy for gMG, while immunoglobulin and advanced treatments became more common over successive treatment episodes. The high prevalence of MG-related clinical events within the first year post-gMG diagnosis, despite treatment with conventional therapies, suggests the need for more effective and earlier interventions.