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Tunçer Çağlayan S, Elibol B, Severcan F, Basar Gursoy E, Tiftikcioglu BI, Gungordu Dalar Z, Celik C, Dai AS, Karaçam S. Insights from CD71 presentation and serum lipid peroxidation in myasthenia gravis - A small cohort study. Int Immunopharmacol 2024; 140:112787. [PMID: 39088914 DOI: 10.1016/j.intimp.2024.112787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/15/2024] [Accepted: 07/23/2024] [Indexed: 08/03/2024]
Abstract
Myasthenia gravis (MG) is a multifaceted autoimmune disorder affecting the postsynaptic neuromuscular junction. In this study, we examined CD4+ and CD8+ T lymphocyte levels and ratios within peripheral blood mononuclear cells (PBMCs) in MG patients. Additionally, we assessed lymphocytes for the expression of CD71, which functions as a transferrin receptor mediating the uptake of iron into the cells. Building on recent discussions regarding CD20 depletion treatments in MG, we also scrutinized lymphocytes for CD20 expression. Comparative analyses were conducted among healthy controls, newly diagnosed MG patients, those undergoing pyridostigmine treatment alone, and MG patients receiving combination therapies. In the patients, the ratio of CD3+CD4+ T lymphocytes to CD3+ T lymphocytes was found to be decreased compared to the healthy controls, while the ratio of CD3+CD8+ cells to CD3+CD4+ cells increased. An increase in the percentage of CD71-expressing lymphocytes was observed in MG patients compared to the healthy control group, while CD20+ lymphocytes exhibited no statistical changes. Moreover, heightened serum lipid peroxidation levels were found in MG patients. These results suggest a possible relationship between iron metabolism, levels of CD71-expressing cells, and lipid peroxidation in MG. Conversely, pyridostigmine treatment reduced the levels of CD71-expressing cells and lipid peroxidation, suggesting potential immunomodulatory and antioxidant impacts of pyridostigmine in MG, either directly or indirectly.
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Affiliation(s)
- Sinem Tunçer Çağlayan
- Bilecik Şeyh Edebali University, Vocational School of Health Services, Department of Medical Services and Techniques, Bilecik, Turkey.
| | - Birsen Elibol
- Istanbul Medeniyet University, Faculty of Medicine, Department of Medical Biology, Istanbul, Turkey
| | - Feride Severcan
- Altınbaş University, Faculty of Medicine, Department of Biophysics, Istanbul, Turkey
| | - Esra Basar Gursoy
- Bezmialem Vakıf University, Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | | | - Zeynep Gungordu Dalar
- Altınbaş University, Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Ceren Celik
- Altınbaş University, Institute of Graduate Studies, Biomedical Sciences Graduate Program, Istanbul, Turkey
| | - Ayse Suna Dai
- Istanbul University, Faculty of Science, Department of Biology, Istanbul, Turkey
| | - Sevinç Karaçam
- Bilecik Şeyh Edebali University, Department of Biotechnology, Bilecik, Turkey
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Suresh S, Watanabe M, Reynolds EL, Callaghan BC. Possible sex and racial disparities in myasthenia gravis care. Muscle Nerve 2024. [PMID: 39072773 DOI: 10.1002/mus.28215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 07/01/2024] [Accepted: 07/14/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION/AIMS Given the importance of early diagnosis and treatment of myasthenia gravis (MG), it is critical to understand disparities in MG care. We aimed to determine if there are any differences in testing, treatment, and/or access to neurologists for patients of varying sex and race/ethnicity with MG. METHODS We used a nationally representative healthcare claims database of privately insured individuals (2001-2018) to identify incident cases of MG using a validated definition. Diagnostic testing, steroid-sparing agents, intravenous immunoglobulin (IVIG), plasma exchange (PLEX), and thymectomy were defined using drug names or CPT codes. Steroid use was defined using AHFS class codes. We also determined whether an individual had a visit to a neurologist and the time between primary care and neurologist visits. Logistic regression determined associations between sex and race/ethnicity and testing, treatments, and access to neurologists. RESULTS Female patients were less likely to get a computed tomography (CT) chest (odds ratio (OR) 0.73, 95% confidence interval (CI): 0.64-0.83), receive steroids (OR: 0.85, 95% CI: 0.75-0.97), steroid-sparing agents (OR: 0.84, 95% CI: 0.72-0.97), and IVIG or PLEX (OR: 0.80, 95% CI: 0.67-0.95). Black patients were less likely to receive steroids (OR: 0.78, 95% CI: 0.63-0.96). No significant disparities were seen in access to neurologists. DISCUSSION We found healthcare disparities in MG treatment with female and Black patients receiving less treatment than men and those of other races/ethnicities. Further research and detailed assessments accounting for individual patient factors are needed to confirm these apparent disparities.
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Affiliation(s)
- Shriya Suresh
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Maya Watanabe
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Evan L Reynolds
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian C Callaghan
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
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Beland B, Perera T, Lee A, Greenfield J, Korngut L, Jewett G. No sex-based differences in odds of starting or time to treatment of generalized myasthenia gravis: A single center cohort study. Muscle Nerve 2024. [PMID: 39054840 DOI: 10.1002/mus.28210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 07/07/2024] [Accepted: 07/14/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION/AIMS Females with generalized myasthenia gravis (gMG) report lower quality of life (QoL) and have more severe disease than males. Sex differences in disease characteristics exist, however whether there are sex differences in the treatment of gMG that may contribute to QoL disparities is unknown. Our objective is to determine whether there are sex differences in the treatment of gMG. METHODS We performed a single-center retrospective study of people diagnosed with gMG at the University of Calgary between 1997 and 2021. Primary outcome was proportion starting treatment and secondary outcome was time from diagnosis to treatment initiation. Treatments included pyridostigmine, prednisone, steroid sparing therapies (azathioprine, mycophenolate mofetil [MMF], methotrexate [MTX], or tacrolimus), intravenous immunoglobulin (IVIg), plasmapheresis, rituximab, eculizumab, cyclosporine, stem cell transplantation, and thymectomy. Multivariable logistic and Cox proportional hazards regression models were used to examine treatment associations with sex, adjusted for time from onset to diagnosis, age at diagnosis, presence of thymoma, and antibody status. RESULTS A total of 179 people with gMG were included (41.9% female). Odds of starting treatment were not statistically associated with sex after adjustment for confounders and correction for multiple testing. Results of the secondary analysis using time to treatment initiation as the outcome were similar. DISCUSSION We found no sex differences in odds of starting treatment or time to treatment initiation that might explain previously observed sex-based differences in QoL. Future work should capture physician and patient treatment preferences that may influence disease management.
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Affiliation(s)
- Benjamin Beland
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tefani Perera
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Angela Lee
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jamie Greenfield
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence Korngut
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gordon Jewett
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Kartika L, Subadi I, Pawana IPA, Andriana M, Sugianto P. Correlation of fatigue on walking ability in myasthenia gravis patients: a cross-sectional study. Ann Med Surg (Lond) 2024; 86:115-120. [PMID: 38222720 PMCID: PMC10783269 DOI: 10.1097/ms9.0000000000001508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/03/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Myasthenia gravis (MG) is a neuromuscular junction autoimmune disease characterised of intermittent muscle weakness that increases with activity and recovers with rest. Objective Analysing the correlation of fatigue on walking ability in MG patients. Methods This study used a cross-sectional design with consecutive sampling. Participants MG patients took in this trial. Data collection encompasses fatigue and walking ability, with fatigue being assessed using the fatigue severity scale (FSS) and walking ability being assessed using the 10-metre walking test. The 10-metre walking test assessment contains three components: comfortable walking speed (CWS), maximum walking speed (MWS), and natural cadence. The statistical analysis used in this study includes the Pearson correlation and Spearman rank tests with P<0.05. Results The number of participants was 23 MG patients, and most of the participant was female (69.6%). The participant's fatigue value was 5.46±1.13, including MGFA 1=5.32±1.15, MGFA 2A=5.5±1.11, and MGFA 2B=5.61±1.30. Meanwhile, the participant's walking abilities included CWS of 1.10±0.11 m/s, MWS of 1.31±0.15 m/s, and natural cadence of 110.91±7.74 steps/min. No significant correlation of fatigue on walking ability including FSS vs. CWS (r=-0.141; P=0.520), FSS vs MWS (r=-0.169; P=0.442), and FSS vs. natural cadence (r=-0.050; P=0.822). Conclusion There was no significant correlation between fatigue and walking ability in MG patients who had MGFA 1, MGFA 2A, and MGFA 2B.
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Affiliation(s)
- Lisa Kartika
- Study Program of Physical Medicine and Rehabilitation, Faculty of Medicine, Airlangga University
| | - Imam Subadi
- Departments of Physical Medicine and Rehabilitation
| | | | | | - Paulus Sugianto
- Neurology, Faculty of Medicine, Airlangga University—Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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Wilcke H, Glaubitz S, Kück F, Anten C, Liebetanz D, Schmidt J, Zschüntzsch J. Female sex and overweight are associated with a lower quality of life in patients with myasthenia gravis: a single center cohort study. BMC Neurol 2023; 23:366. [PMID: 37817097 PMCID: PMC10563278 DOI: 10.1186/s12883-023-03406-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/27/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Myasthenia gravis (MG) affects individuals as a chronic autoimmune disease for many years. Commonly, chronic diseases significantly reduce the patients' quality of life. Aiming to improve the future quality of life in MG, this study assessed the factors impacting quality of life. As gender-specific medicine is becoming increasingly important, this study also focused on understanding gender differences in the outcome of MG. METHODS The study is a combined monocentric, retrospective and prospective database analysis of patient records based on 2,370 presentations of 165 patients with clinically, serologically and/or electrophysiologically confirmed MG over an observation period of up to 47 years. The data collection included the following parameters: antibody status, disease severity, age, medication use, gender, and disease duration. In addition, a prospective survey was conducted on the quality of life using the Myasthenia gravis-specific 15-item Quality of Life scale (MG-QoL15) and on the activities of daily living using the MG-specific Activities of Daily Living scale (MG-ADL). RESULTS Of the 165 patients, 85 were male (51.5%) and 80 were female (48.5%). The remaining baseline characteristics (e.g. age and antibody status) were consistent with other myasthenia gravis cohorts. A high body mass index (BMI) (p = 0.005) and a high disease severity (p < 0.001) were significantly associated with lower disease-specific quality of life. Additionally, the quality of life in women with MG was significantly reduced compared to male patients (19.7 vs. 13.0 points in the MG-QoL15, p = 0.024). Gender differences were also observable in terms of the period between initial manifestation and initial diagnosis and women were significantly more impaired in their activities of daily living (MG-ADL) than men (4.8 vs. 3.0 points, p = 0.032). CONCLUSION Women with MG had significantly poorer disease specific quality of life compared to men as well as patients with a higher BMI. In order to improve the quality of life, gender-specific medicine and further investigation regarding a modification of the quality of life by lowering the BMI are essential and necessary. TRIAL REGISTRATION Study approval by the Ethics Committee of the University Medical Center Göttingen was granted (number 6/5/18).
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Affiliation(s)
- Hannah Wilcke
- Department of Neurology, University Medical Center, Göttingen, Germany
| | - Stefanie Glaubitz
- Department of Neurology, University Medical Center, Göttingen, Germany
| | - Fabian Kück
- Department of Medical Statistics, University Medical Center, Göttingen, Germany
| | - Christoph Anten
- Department of Medical Statistics, University Medical Center, Göttingen, Germany
| | - David Liebetanz
- Department of Neurology, University Medical Center, Göttingen, Germany
| | - Jens Schmidt
- Department of Neurology, University Medical Center, Göttingen, Germany
- Department of Neurology and Pain Treatment, Immanuel Clinic Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Jana Zschüntzsch
- Department of Neurology, University Medical Center, Göttingen, Germany.
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Xu RH, Yu S, Liu J, Zhang S, Dong D. Developing the health state classification system for a condition-specific preference-based measure for patients with myasthenia gravis. Disabil Rehabil 2023; 45:3366-3372. [PMID: 36102606 DOI: 10.1080/09638288.2022.2120096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/22/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study aimed to generate the health state classification system (HCS) of a condition-specific preference-based measure to capture the health-related quality of life (HRQoL) of patients with myasthenia gravis (MG) from the 15-item Myasthenia Gravis Quality of Life Scale (MG-QoL15r). MATERIALS AND METHODS An HCS was derived from the MG-QoL15r in a large sample of 1739 patients with MG based on psychometric analysis, including factor analysis, item response theory analysis, and discussions with experts. Reliability, construct and convergent validity, and item fit of the HCS were further assessed using another sample. RESULTS The HCS has six dimensions: social activity, hobbies and fun activities, meeting family needs, work performance, mobility, and emotion, and it demonstrates good internal consistency reliability. The unidimensionality of the HCS was confirmed using confirmatory factor analysis. Satisfied convergent validity was supported by a significant association with the 12-item Short Form Survey (SF-12). CONCLUSIONS Based on a solid process of development and consultations with clinical professionals and patients, a valid MG-specific preference-based measure, MGQoL-6D, was developed. Further research will estimate the local preference weight to support the MG-related cost-utility analysis.IMPLICATION FOR REHABILITATIONA new condition-specific health state classification system (HCS) named Myasthenia gravis Quality of Life Scale (MGQoL-6D) is proposed.MGQoL-6D classifies MG health states as a combination of six dimensions with three response levels.The dimensions of the HCS are social activity, hobbies and fun activity, family needs, work performance, mobility, and emotion.The HCS and the upcoming value set of the MGQoL-6D could support the cost-effectiveness analysis of MG-related clinical and rehabilitated interventions.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Siyue Yu
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ji Liu
- Beijing Aili Myasthenia Gravis Care Center, Beijing, China
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Dong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
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Cavanagh N, Shrubsole K, Alsop T, Williams K. Exploring impairments and allied health professional utilisation in people with myasthenia gravis: A cross-sectional study. J Clin Neurosci 2023; 114:9-16. [PMID: 37276742 DOI: 10.1016/j.jocn.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 05/12/2023] [Accepted: 05/20/2023] [Indexed: 06/07/2023]
Abstract
This study aimed to explore how people with myasthenia gravis experience impairments in vision, dizziness, hearing, and fatigue, and how these relate to balance confidence, community participation, and health-related quality of life. Additionally, this study investigated the utilisation and perception of the allied health role in managing these impairments in the Australian context. Visual and hearing impairments, along with fatigue, were found to be correlated with health-related quality of life and community participation to varying degrees, while visual impairment and dizziness were correlated with balance confidence. Perception and utilisation of allied health professionals was variable; common barriers to better utilisation included participant perception of clinicians having poor knowledge around myasthenia gravis, previous poor experiences with clinicians, uncertainty about the clinicians' role, and lack of awareness that symptoms were associated with myasthenia gravis. Further research exploring clinicians' knowledge of myasthenia gravis is recommended, along with education for people with the disease about symptoms associated and how to appropriately access care.
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Affiliation(s)
- Neve Cavanagh
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Kirstine Shrubsole
- School of Health and Human Sciences, Southern Cross University, Gold Coast, Australia.
| | - Tahlia Alsop
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Katrina Williams
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
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Hamedani AG, McPherson TO, Aban I, Lee I, Kupersmith MJ, Wolfe GI, Kaminski HJ. Attitudes and Beliefs Toward Thymectomy in the Myasthenia Gravis Patient Registry. J Clin Neuromuscul Dis 2023; 24:222-228. [PMID: 37219866 DOI: 10.1097/cnd.0000000000000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To evaluate patient attitudes and beliefs toward thymectomy for myasthenia gravis (MG). METHODS The Myasthenia Gravis Foundation of America administered a questionnaire to the MG Patient Registry, an ongoing longitudinal survey of adult MG patients. Questions assessed reasons for or against thymectomy and how hypothetical scenarios would have affected their decision. RESULTS Of 621 respondents, 190 (31%) reported a history of thymectomy. Of those who underwent thymectomy for nonthymomatous MG, 97 (51.6%) ranked symptom improvement as most important and 100 (53.2%) ranked reducing medication as least important. Among 431 nonthymectomy patients, the most frequent reason for not undergoing thymectomy was that their doctor did not discuss it (152 of 431 = 35.2%) and 235 (56.8%) said that they would have considered it more strongly if their doctor spent more time discussing it. CONCLUSIONS Thymectomies are motivated more by symptoms than by medication, and a lack of neurologist discussion is the most common barrier to thymectomy.
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Affiliation(s)
- Ali G Hamedani
- Departments of Neurology and Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Tarrant O McPherson
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham AL
| | - Inmaculada Aban
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham AL
| | - Ikjae Lee
- Department of Neurology, Columbia University, New York, NY
| | - Mark J Kupersmith
- Departments of Neurology, Icahn School of Medicine at Mount Sinai and New York Eye and Ear Infirmary, New York, NY
| | - Gil I Wolfe
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY; and
| | - Henry J Kaminski
- Department of Neurology, George Washington University, Washington, DC
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De León AM, Aban I, McPherson T, Granit V, Benatar M, Cutter G, Lee I. Impact of the COVID-19 pandemic on patients with myasthenia gravis: A survey of the Myasthenia Gravis Foundation of America MG patient registry. Muscle Nerve 2023; 67:25-32. [PMID: 36324261 PMCID: PMC9877793 DOI: 10.1002/mus.27743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION/AIMS Factors associated with coronavirus disease 2019 (COVID-19) infection among the myasthenia gravis (MG) population are incompletely understood. This study aimed to characterize the behavior of MG patients during the pandemic and to examine risk factors associated with COVID-19 infection. METHODS A "COVID-19 Survey" was sent to MG Patient Registry participants in the summer of 2020 (CSS20) and winter of 2021 (CWS21). Survey results were summarized descriptively. Demographics, disease characteristics, medication use, and survey results were compared between those reporting COVID-19 diagnosis (COVID), COVID-19 like symptoms without diagnosis (COVID-Like), and asymptomatic participants. RESULTS A total of 454 and 665 participants completed the CSS20 and CWS21 surveys respectively; 326 participants completed both. Most continued follow-up visits and MG treatments. The frequency of COVID-like symptoms was similar between CSS20 and CWS21, while COVID-19 exposure (6% vs. 27%), COVID-19 testing among symptomatic individuals (35% vs. 78%), and COVID-19 diagnosis (0.2% vs. 6%) were higher in the CWS21. Cough, fever, fatigue, myalgia, anosmia/ageusia, and hospital and intensive care unit (ICU) admissions were more frequent in the COVID compared to the COVID-Like group. COVID-19 exposure (odds ratio [OR] 7.88), number of people in the household (OR 1.31), and report of MG exacerbation before the pandemic (OR 2.6) were independently associated with COVID-19 infection. DISCUSSION COVID-19 affected MG patients increasingly through the early pandemic. While face-to-face contact with a COVID-19 infected individual was an obvious risk factor, MG patients who had more people in the household and unstable disease were at elevated risk for COVID-19 infection.
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Affiliation(s)
| | - Inmaculada Aban
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Tarrant McPherson
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Volkan Granit
- Department of NeurologyUniversity of MiamiMiamiFloridaUSA
| | | | - Gary Cutter
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Ikjae Lee
- Department of NeurologyColumbia UniversityNew YorkNew YorkUSA
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10
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Mental health in myasthenia gravis patients and its impact on caregiver burden. Sci Rep 2022; 12:19275. [PMID: 36369246 PMCID: PMC9652470 DOI: 10.1038/s41598-022-22078-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
Psychiatric comorbidities are relevant in patients with Myasthenia gravis (MG). Also, MG patients experience a reduced health-related quality of life (HRQoL). We aimed to quantify the impact of depression as well as self-perceived MG severity on HRQoL and caregivers' burden. In this cross-sectional study, we used a survey encompassing demographic, disease-related information, and standardized questionnaires to assess symptoms of depression, anxiety, HRQoL (MG Quality of Life scale; MG-QoL15), and caregiver burden (Burden Scale for Family Caregivers; BSFC). Data from 1399 participating patients (96%) and 1042 caregivers (65%) were eligible for further analysis. Symptoms of depression and anxiety disorder were indicated by 31% and 36% of patients. Self-reported MG severity (MG severity) and MG-QoL15 scores were strongly associated (estimated marginal means for severe versus mild MG severity = 18 95% CI [16; 21]; p ≤ 0.001). Adjusting for symptoms of depression decreased the estimated strength of this association (estimated marginal means for severe versus mild MG severity = 15 [13; 17]; p ≤ 0.001). Caregiver burden was associated to MG disease severity (estimated marginal means for severe vs. mild MG severity = 0.16 [0.13; 0,19); p ≤ 0.001) and also negatively influenced by symptoms of depression (estimated marginal means = 0.12 [0.09; 0.15]). Symptoms of depression and anxiety disorder in MG are frequent. Beyond MG severity, symptoms of depression have negative effects on HRQoL as well as on caregivers' burden. Diagnosis and treatment of psychiatric comorbidities should be considered an important element in MG care. Screening tools for mental health conditions should be implemented at least in specialized MG centers.
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Lee I, Leach JM, Aban I, McPherson T, Duda PW, Cutter G. One-year follow-up of disease burden and medication changes in patients with myasthenia gravis: From the MG Patient Registry. Muscle Nerve 2022; 66:411-420. [PMID: 35673964 PMCID: PMC9796266 DOI: 10.1002/mus.27659] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 05/31/2022] [Accepted: 06/04/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION/AIMS We studied the progression of myasthenia gravis (MG) disease burden and medication adjustment among MG Patient Registry participants. METHODS Participants diagnosed with MG (age ≥18 years), registered between July 1, 2013 and July 31, 2018 and completing both 6- and 12-month follow-up surveys, were included in this investigation. Participants were grouped into high-burden (Myasthenia Gravis Activity of Daily Living scale [MG-ADL] score ≥6) and low-burden (MG-ADL <6) groups based on MG-ADL scores at enrollment. Demographics and disease history were compared between groups. MG-ADL score change and medication changes (escalation, no change, de-escalation) between enrollment and 12-month follow-up were compared between groups. Minimal symptom expression (MSE, MG-ADL <2) at 12 months was compared between groups. Logistic regression analysis was performed to study factors associated with MSE at 12 months. RESULTS In total, 520 participants (56% female) were included in high-burden (n = 248) and low-burden (n = 272) groups. Those in the high-burden group were more likely to be younger, female, and have shorter disease duration. At 12 months, MSE was achieved in 6% of the high-burden group and newly achieved (42 of 201, 21%) or maintained (52 of 71, 73%) in the low-burden group. In the multivariable analysis, being in the high-burden group and use of pyridostigmine were associated with less likelihood of MSE, whereas MG-ADL score improvement (>2 or >20%) at 6 months significantly increased the likelihood of achieving MSE at 12 months (P = .0004). DISCUSSION In both groups, but more so in the high-burden group, patients infrequently achieved MSE after 1 year of MG treatment. Baseline low disease burden, improvement at 6 months and no pyridostigmine use were associated with a higher likelihood of MSE at 12 months.
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Affiliation(s)
- Ikjae Lee
- The Neurological Institute of New YorkColumbia UniversityNew YorkNew YorkUSA
| | - Justin M. Leach
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Inmaculada Aban
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Tarrant McPherson
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Petra W. Duda
- Department of Clinical Research, Ra Pharmaceuticals, IncCambridgeMassachusettsUSA
| | - Gary Cutter
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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12
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Kaminski HJ, Denk J. Corticosteroid Treatment-Resistance in Myasthenia Gravis. Front Neurol 2022; 13:886625. [PMID: 35547366 PMCID: PMC9083070 DOI: 10.3389/fneur.2022.886625] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/21/2022] [Indexed: 12/25/2022] Open
Abstract
Chronic, high-dose, oral prednisone has been the mainstay of myasthenia gravis treatment for decades and has proven to be highly beneficial in many, toxic in some way to all, and not effective in a significant minority. No patient characteristics or biomarkers are predictive of treatment response leading to many patients suffering adverse effects with no benefit. Presently, measurements of treatment response, whether taken from clinician or patient perspective, are appreciated to be limited by lack of good correlation, which then complicates correlation to biological measures. Treatment response may be limited because disease mechanisms are not influenced by corticosteroids, limits on dosage because of adverse effects, or individual differences in corticosteroids. This review evaluates potential mechanisms that underlie lack of response to glucocorticoids in patients with myasthenia gravis.
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Affiliation(s)
- Henry J Kaminski
- Department of Neurology and Rehabilitation Medicine, George Washington University, Washington, DC, United States
| | - Jordan Denk
- Department of Neurology and Rehabilitation Medicine, George Washington University, Washington, DC, United States
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13
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Diez Porras L, Homedes C, Alberti MA, Velez Santamaria V, Casasnovas C. Quality of Life in Myasthenia Gravis and Correlation of MG-QOL15 with Other Functional Scales. J Clin Med 2022; 11:jcm11082189. [PMID: 35456281 PMCID: PMC9025772 DOI: 10.3390/jcm11082189] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/04/2022] [Accepted: 04/11/2022] [Indexed: 01/25/2023] Open
Abstract
Health-related quality of life (HRQOL) in myasthenia gravis (MG) is frequently decreased. Further, there are many validated clinical scales and questionnaires to evaluate the clinical status in MG. We aimed to determine if there was an improvement in HRQOL following an intensive treatment for MG, identify which demographic and clinical features influenced patients’ HRQOL, and investigate if the questionnaire MG-QOL15 correlated with other evaluation scales. We recruited 45 patients with generalised MG who were starting immunomodulatory treatment with intravenous immunoglobulins and prednisone for the first time. At each visit, we administered several validated scales for MG. The mean MG-QOL15 score improved significantly at 4 and 6 weeks of the study. Additionally, the MG-QOL15 score correlated strong with the Myasthenia Gravis-Activities of Daily Living (MG-ADL) and the Neuro-QOL Fatigue and weakest with the Quantitative Myasthenia Gravis Scoring System (QMG). The QMG score prior to study enrolment was associated with HRQOL. We observed that HRQOL in MG improved after receiving an intensive immunomodulatory treatment and achieving better control of the symptoms. The questionnaire MG-QOL15 correlated positively with other clinical measures. As MG is a fluctuating condition, and some symptoms are difficult to examine, we direct physicians toward the use of scales and questionnaires composed of items perceived by the patient.
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Affiliation(s)
- Laura Diez Porras
- Neurometabolic Diseases Group, Bellvitge Biomedical Research Institute (IDIBELL), 199 Granvia de l’Hospitalet, 08908 L’Hospitalet de Llobregat, Spain; (L.D.P.); (C.H.); (M.A.A.); (V.V.S.)
| | - Christian Homedes
- Neurometabolic Diseases Group, Bellvitge Biomedical Research Institute (IDIBELL), 199 Granvia de l’Hospitalet, 08908 L’Hospitalet de Llobregat, Spain; (L.D.P.); (C.H.); (M.A.A.); (V.V.S.)
| | - Maria Antonia Alberti
- Neurometabolic Diseases Group, Bellvitge Biomedical Research Institute (IDIBELL), 199 Granvia de l’Hospitalet, 08908 L’Hospitalet de Llobregat, Spain; (L.D.P.); (C.H.); (M.A.A.); (V.V.S.)
- Neuromuscular Unit, Department of Neurology, Bellvitge University Hospital, Feixa Llarga Street n/n, 08907 L’Hospitalet del Llobregat, Spain
| | - Valentina Velez Santamaria
- Neurometabolic Diseases Group, Bellvitge Biomedical Research Institute (IDIBELL), 199 Granvia de l’Hospitalet, 08908 L’Hospitalet de Llobregat, Spain; (L.D.P.); (C.H.); (M.A.A.); (V.V.S.)
- Neuromuscular Unit, Department of Neurology, Bellvitge University Hospital, Feixa Llarga Street n/n, 08907 L’Hospitalet del Llobregat, Spain
| | - Carlos Casasnovas
- Neurometabolic Diseases Group, Bellvitge Biomedical Research Institute (IDIBELL), 199 Granvia de l’Hospitalet, 08908 L’Hospitalet de Llobregat, Spain; (L.D.P.); (C.H.); (M.A.A.); (V.V.S.)
- Neuromuscular Unit, Department of Neurology, Bellvitge University Hospital, Feixa Llarga Street n/n, 08907 L’Hospitalet del Llobregat, Spain
- Center for Biomedical Research on Rare Diseases (CIBERER), ISCIII, 3–5 Monforte de Lemos, Pabellón 121, 28029 Madrid, Spain
- Correspondence:
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14
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Thomsen JLS, Vinge L, Harbo T, Andersen H. A population-based follow-up study of maximal muscle strength and mobility in patients with myasthenia gravis. Neuromuscul Disord 2022; 32:305-312. [DOI: 10.1016/j.nmd.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 01/23/2022] [Accepted: 02/15/2022] [Indexed: 10/19/2022]
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15
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Gutierrez G, Girma H, Kuhnell P, Macaluso M, Kaminski HJ. Impact of the Covid-19 epidemic on a US sample of patients with myasthenia gravis. THERAPEUTIC ADVANCES IN RARE DISEASE 2022; 3:26330040221082673. [PMID: 37125217 PMCID: PMC10032427 DOI: 10.1177/26330040221082673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/04/2022] [Indexed: 05/02/2023]
Abstract
Introduction The Covid-19 pandemic has devastated the world and demonstrated the inadequacy of health care in the United States. To assess its impact, the Rare Disease Clinical Research Network conducted a survey to assess the pandemic on the rare disease community of patients, including those with myasthenia gravis (MG). Methods A cross-sectional survey was designed to target people or their care givers who live in the United States, have a rare disease, and are under 90 years of age. Respondents logged onto a dedicated web page and completed the survey online, which requested demographic, disease-specific, drug treatment, and symptom information as well as assessment of Covid-19 impact on them. The survey was open from May 2020 to December 2020. Results Five hundred ninety-four with self-reported myasthenia gravis completed the survey, which was the largest number of respondents. Sixty percent of respondents were women with a mean age of 60 years. Eighty-nine percent identified as White. Respondents did not appreciate a worsening of symptoms after the pandemic. Only 7 respondents reported the diagnosis of Covid-19 but 11% indicated they had difficulty accessing care at the time of the survey. Discussion and Conclusion Patients with MG complained of worse access to medical care during the early months of the pandemic, including challenges in diagnosis of suspected Covid-19 infection. A major limitation of the survey is its inability to access minority populations. Nevertheless, the results of the Rare Disease Clinical Research Network (RCDRN) survey of patients with MG provide clear evidence that the pandemic has demonstrated the deficiencies in US healthcare.
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Affiliation(s)
| | | | - Pierce Kuhnell
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Maurizio Macaluso
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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16
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Moodley K, Bill PLA, Patel VB. A Comparison of Clinical, Electro-Diagnostic, Laboratory, and Treatment Outcome Differences in a Cohort of HIV-Infected and HIV-Uninfected Patients With Myasthenia Gravis. Front Neurol 2021; 12:738813. [PMID: 34721269 PMCID: PMC8553930 DOI: 10.3389/fneur.2021.738813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
There is limited literature comparing the clinical parameters and treatment outcomes in HIV-infected and HIV-uninfected myasthenia gravis (MG) patients. The aim of the study was to investigate the clinical differences and treatment outcomes in the two categories of patients, particularly the safe use of immunosuppressive therapy in immunocompromised patients. The study was a retrospective analysis of medical records of MG patients from the neuromuscular unit at Inkosi Albert Luthuli Central Hospital in Kwa-Zulu Natal between 2003 and 2019. One hundred and seventy-eight (178) patients fulfilled the clinical criteria for MG. Twenty-four (13.4%) were HIV-infected and 154 (86.5%) were HIV-uninfected. There were 116 (65%) females, median 45 years, (IQR 40–62), 90 (50.5%) black African, 66 (37%) Indian, 20 (11.2%) white, and 2 (1.1%) of mixed ancestry. In the HIV-infected cohort, 20 (87%) had generalized MG, 12 (50%) bulbar, and 14 (60.9%) respiratory onset MG, 12 (50%) presented with MG Foundation of America (MGFA) class five diseases at diagnosis, six (25%) presented with MG crisis during the 5-year follow-up. Thirteen (54%) of the HIV-infected group required rescue therapy using (plasma exchange or IV immunoglobulin) combined with pulse cyclophosphamide compared with 17 (11%) in the HIV-uninfected cohort, respectively. At 5 years, 8 (33%) of the HIV-infected group remained refractory to treatment compared with 10 (6.5%) HIV-uninfected cohort, respectively. No adverse events were documented in HIV-infected patients receiving combination rescue therapy (PLEX or IVIG combined with IV cyclophosphamide). In conclusion HIV-infected MG patients are more likely to require combination rescue therapy with PE/IVIG and IV cyclophosphamide compared with those who were HIV-uninfected. No side effects were documented in the HIV-infected group receiving the above therapy.
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Affiliation(s)
- Kaminie Moodley
- Department of Neurology, University of KwaZulu-Natal, Durban, South Africa
| | - Pierre L A Bill
- Department of Neurology, University of KwaZulu-Natal, Durban, South Africa
| | - Vinod B Patel
- Department of Neurology, University of KwaZulu-Natal, Durban, South Africa
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Luo Y, Dong X, Peng Y, Cui B, Yan C, Jin W, Li Y, Zhou R, Huang K, Yang H. Evaluation of outcome measures for myasthenia gravis subgroups. J Clin Neurosci 2021; 91:270-275. [PMID: 34373039 DOI: 10.1016/j.jocn.2021.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/11/2021] [Accepted: 07/16/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Disease evaluation and long-term follow-up of myasthenia gravis (MG) patients rely on disease-specific measures. We evaluated four widely used MG-specific assessments, and compared the response to disease change in different MG subgroups. METHODS We used the Cronbach's α coefficient to test reliability, Pearson correlation coefficients to test construct validity, as well as one-way ANOVA and independent-sample t-tests to access discriminant validity. Analyses of similar items between QMG and MG-ADL included paired-sample t-tests and mean score comparisons. Pearson correlation coefficients were used to describe the correlation between changes of QMG, MG-ADL, MG-QOL15r and MGC. The Wilcoxon matched-pairs signed-ranks test was performed to compare the outcomes. RESULTS 872 MG patients were enrolled. QMG, MG-ADL, MG-QOL15r, and MGC all exhibited high reliability. All four scales displayed good discriminant validity according to the MGFA classification and MGC score. MG-ADL showed significant differences between patients grouped by age and gender, and MG-QOL15r showed significant differences between patients grouped by age. Analyses of similar items showed that MG-ADL achieved higher scores in bulbar items, whereas QMG produced higher scores in limb items. For patients in remission or minimal manifestation status, QMG exhibited significantly greater improvement than MG-QOL15r. In patients of MGFA I, II, III, and IV, QMG showed significantly greater improvement than MG-ADL. CONCLUSIONS Patient-reported scale is an important supplement for a given period. MG-ADL has a better response to severe disease, and MG-QOL15r is more comprehensive for patients in remission or minimal manifestation status.
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Affiliation(s)
- Yien Luo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, PR China
| | - Xiaohua Dong
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, PR China
| | - Yuyao Peng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, PR China
| | - Biqi Cui
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, PR China
| | - Chengkai Yan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, PR China
| | - Wanlin Jin
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, PR China
| | - Yi Li
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, PR China
| | - Ran Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, PR China
| | - Kun Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, PR China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, PR China.
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18
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Thomsen JLS, Vinge L, Harbo T, Andersen H. Gender differences in clinical outcomes in myasthenia gravis: A prospective cohort study. Muscle Nerve 2021; 64:538-544. [PMID: 34036597 DOI: 10.1002/mus.27331] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION/AIMS It is uncertain whether clinical outcomes differ between male and female patients with myasthenia gravis (MG) while receiving standard clinical care. METHODS In a prospective cohort study of 107 patients with MG receiving standard of care from 2012 to 2019, the Quantitative MG (QMG), the MG Composite (MGC), the MG Activities of Daily Living (MG-ADL), and the MG Quality of Life 15-Items (QOL15) were determined. Clinical outcomes were analyzed in relation to gender. RESULTS Mean follow-up time was 4.8 (±0.4) y, and 70 patients completed all follow-up assessments. Patients improved on all clinical scores: QMG -1.8 (P < .001), MGC -1.5 (P < .001), MG-ADL -1.3 (P < .001), and QOL15 -3.0 (P < .001). Females improved less than males on the QMG (P = .01), MGC (P < .001), MG-ADL (P = .006), and QOL15 (P < .001) independent of potential confounders. Males had moderate to strong correlations between changes in all clinical scales (r range 0.52 to 0.73), whereas females had weak correlations between changes in the QMG and MG-ADL (r = 0.13), the QMG and QOL15 (r = 0.27), the MGC and MG-ADL (r = 0.21), the MGC and QOL15 (r = 0.00), and the MG-ADL and QOL15 (r = 0.31). DISCUSSION Females improved less compared to males on objective and patient-reported outcomes. Moreover, females improved more on objective measures than on patient-reported outcomes. These gender differences should receive attention in clinical care and in the design of future trials.
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Affiliation(s)
- Jan L S Thomsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | - Lotte Vinge
- Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Al-Ahmer I, Elshony H. Determinants of quality of life changes with plasmapheresis in patients with myasthenia gravis. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00320-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Immunomodulation, including IVIG and plasma exchange, is useful for a crisis or severe exacerbation. Plasma exchange may be slightly faster and more effective in a myasthenic crisis than IVIG. The aim of the current study was to determine the changes in the quality of life (QOL) after plasmapheresis and factors influencing these changes.
Results
This study was conducted on 98 MG patients diagnosed as moderate to severe myasthenia gravis (according to Myasthenia Gravis Foundation of America classification), 81 patients received alternate day 5 sessions plasmapheresis (TPE group) and 17 patients were on medical treatment only (control group). All patients were subjected to full history, through clinical neurological evaluation and scored with quantitative myasthenia gravis (QMG) score for MG severity at start and after 1 m. Both groups completed the QOL questionnaire at baseline and after 1 month. The MG-QOL-15 scores were computed and we analyzed the change in the QOL scores from baseline to after plasmapheresis groups and compared it with the results for the control group. The scores in QOL scales had significantly decreased after plasmapheresis, and the improvement in QOL scores had a good correlation with the decrease in QMGS. The improvement in QOL and QMG was significantly correlated with younger age, female gender, shorter duration of the illness, presence of AchR antibodies, antibody titer, and thymus hyperplasia.
Conclusion
Plasmapheresis is effective in improving quality of life in myasthenia gravis patients and this improvement influenced by age, gender, duration of illness, presence of AchR antibodies and their titer, and the thymus pathology.
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Abstract
OBJECTIVE Our aim is to explore the relationship between myasthenia gravis (MG)-related symptom burden, sleep quality, and fatigue in a diverse group of self-identified MG patients. METHODS Patients provided relevant myasthenia disease data and completed the MG QOL-15, Epworth sleepiness scale, Pittsburgh Sleep Quality Index, and fatigue severity score (FSS) online. MG activities of daily living scale (MG-ADL) was completed on a follow-up telephone interview. RESULTS One hundred ninety-six patients completed the online survey and 99 provided MG-ADL data. The mean age was 52 ± 15.34 years, 88 were acetylcholine receptor antibody positive, and 21 were muscle specific kinase positive. The mean MG-ADL was 6.81, indicating a moderate MG disease burden. Forty-seven (24%) reported high Epworth sleepiness scale scores, 152 (77%) reported high Pittsburgh Sleep Quality Index scores, and 162 (82%) reported high FSS scores. Correlation analysis correcting for body mass index and sleep apnea revealed a moderate positive correlation between MGQOL-15, MG-ADL, and FSS. CONCLUSIONS There is a moderate positive correlation between various MG-specific outcome measures and fatigue severity.
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21
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Alzuabi MA, Manolopoulos A, Elmashala A, Odabashian R, Naddaf E, Murad MH. Immunoglobulin for myasthenia gravis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Muayad A Alzuabi
- Department of Neuroscience, Division of Clinical Neurology; Medical University of South Carolina; Charleston SC USA
| | - Apostolos Manolopoulos
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Amjad Elmashala
- Department of Neurology; Iowa University Hospitals; Iowa City IA USA
| | - Roupen Odabashian
- Department of Internal Medicine; University of Toronto; Toronto Canada
| | - Elie Naddaf
- Department of Neurology; Mayo Clinic; Rochester MN USA
| | - M Hassan Murad
- Mayo Evidence-based Practice Center (EPC); Mayo Clinic; Rochester MN USA
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22
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Szczudlik P, Sobieszczuk E, Szyluk B, Lipowska M, Kubiszewska J, Kostera-Pruszczyk A. Determinants of Quality of Life in Myasthenia Gravis Patients. Front Neurol 2020; 11:553626. [PMID: 33071942 PMCID: PMC7538807 DOI: 10.3389/fneur.2020.553626] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/19/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Although approximately half of myasthenia gravis (MG) patents achieve remission, for the remaining group MG is often a life-long disease. Better understanding of the determinants of Quality of Life (QoL) in MG is needed to optimize treatment goals in chronic cases. Materials and Methods: We performed a single center cross-sectional study in 339 MG adult patients (64.9% women), with ocular or generalized disease. SF-36 and a structured questionnaire was administered, including information on previous and current MG severity, medications, comorbidities, education, occupation and BMI of the patient. Mean disease duration was 7.5 + 9.3 years. Current age was 51.6 + 18.3 years, 55% had Early-Onset (<50 years) MG. Results: There were no statistically significant differences in mean SF-36 subscores between women and men. Worse MGFA class was related to lower QoL in physical (PCS) and mental (MCS) subscore (p = 0.000 for both). Patients with MGFA I-II class had significantly better QoL in physical and mental subscores than patients with more severe MG (p < 0.005). Late-onset MG patients had worse QoL than EOMG in physical score domain PCS (p = 0.049). Overweight and obese patients had lower PCS (p = 0.002) and MCS (p = 0.038) than patients with normal BMI. University education was related to statistically higher PCS (p = 0.015) and MCS (p = 0.006). QoL in currently employed was better in PCS and MCS (p = 0.000), with white collar workers reporting higher PCS (p = 0.049) than the remaining group. Patients living with family evaluated their MCS (p = 0.015) better than living alone. Moderate physical activity (twice a week) improved PCS (p = 0.045). Conclusion: Our study confirmed that greater severity of symptoms, age, age of onset but also BMI, type of work, education status and physical activity affect QoL in MG.
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Affiliation(s)
- Piotr Szczudlik
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Sobieszczuk
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Beata Szyluk
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Marta Lipowska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
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Dong D, Chong MKC, Wu Y, Kaminski H, Cutter G, Xu X, Li H, Zhao C, Yin J, Yu S, Zhu J. Gender differences in quality of life among patients with myasthenia gravis in China. Health Qual Life Outcomes 2020; 18:296. [PMID: 32883289 PMCID: PMC7470440 DOI: 10.1186/s12955-020-01549-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Myasthenia gravis (MG), a chronic neuromuscular disorder, can adversely affect patients’ health-related quality of life (HRQoL), especially in women. The study aimed to evaluate the difference in HRQoL of women and men MG patients and explore the factors that mediate the relationship between gender and HRQoL. Methods A cross-sectional study was conducted among 1815 patients with MG in China. The revised 15-item MG quality of life scale (MG-QOL15r) was used to access patients’ HRQoL in overall, physical, social and emotional domains. Socio-demographic information, diagnosis and treatment history, comorbidities, social support, active lifestyle and the MG activities of daily living scale (MG-ADL) were recorded and compared between women and men using the Student’s t-test and Pearson’s Chi-square test. Multivariable regression analyses were conducted to identify independent contributors to HRQoL, especially those affecting different gender. Results On average, female patients with MG reported a lower MG-QOL15r score than the males (44.49 ± 29.10 vs 49.32 ± 29.18). The association between gender and patients’ HRQoL interacted with the number of comorbidities across the overall, physical and social domains of patients. As the number of comorbidities increased, the scores of HRQoL decreased and it was faster among females than the males (p < 0.05). Moreover, unemployment, exacerbation of the disease, and active lifestyle contributed to the patients’ HRQoL across all domains. Unemployment (β = − 4.99 [95%CI, − 7.80 to − 2.18], p < 0.001) and exacerbations (β = − 8.49 [95%CI, − 11.43 to − 5.54], p < 0.001) were correlated with poorer HRQoL; while an active lifestyle had a positive impact on HRQoL (β = 0.28 [95%CI, 0.16 to 0.40], p < 0.001). Conclusions The results indicate that the HRQoL of women MG patients was lower than that of men. The relationship between gender and HRQoL is modulated by the number of comorbidities. Thus, to improve the HRQoL of women MG patients, symptomatic treatments might not be enough, their comorbid conditions should be considered as well. Additionally, employment status, MG exacerbations, and an active lifestyle have been found as determining factors of the patients’ HRQoL, which suggests future interventions should cope with these factors to improve their quality of life.
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Affiliation(s)
- Dong Dong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Marc Ka-Chun Chong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Yushan Wu
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Henry Kaminski
- Department of Neurology, The George Washington University, Washington, DC, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Xianhao Xu
- Department of Neurology, Beijing Hospital, Beijing, China
| | - Haifeng Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chongbo Zhao
- Department of Neurology, Huashan hospital, Fudan University, Shanghai, China
| | - Jian Yin
- Department of Neurology, Beijing Hospital, Beijing, China.,National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Siyue Yu
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - Jianfeng Zhu
- School of Social Development and Public Policy, Fudan University, Shanghai, China.
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24
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Mendoza M, Tran C, Bril V, Katzberg HD, Barnett C. Patient-acceptable symptom states in myasthenia gravis. Neurology 2020; 95:e1617-e1628. [DOI: 10.1212/wnl.0000000000010574] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/18/2020] [Indexed: 12/13/2022] Open
Abstract
ObjectivesTo estimate patient-acceptable symptom state (PASS) cut points for myasthenia gravis (MG) health scales.MethodsWe conducted an electronic survey that included the Myasthenia Gravis Impairment Index (MGII), EuroQol 5-Dimension (EQ5D), and a simple PASS question. PASS-anchored thresholds were estimated for the MGII questionnaire through receiver operating characteristic curves. We used the MGII PASS cut point in a validation cohort of 257 patients to estimate PASS thresholds for other clinically relevant health scales such as the Quantitative Myasthenia Gravis Scale (QMGS), Myasthenia Gravis Activities of Daily Living (MG-ADL), Myasthenia Gravis Composite (MGC), and Myasthenia Quality of Life (MG-QoL15).ResultsOne hundred twenty-four of ≈250 invited patients answered the electronic survey (49% response rate), and 80 considered their current symptom state acceptable (PASS-positive). They had lower MGII scores than PASS-negative patients (7.76 ± 9.37 vs 25.0 ± 13.7, p < 0.0001) and better EQ5D scores (0.86 ± 0.17 vs 0.69 ± 0.18, p < 0.0001). The MGII questionnaire threshold for PASS was ≤10 points. With the use of this threshold in an independent dataset of 257 patients, all patients in remission or minimal manifestation status were PASS-positive. In addition, some patients in Classes I, II, and IIIA also achieved PASS status. PASS thresholds for the QMGS, MG-ADL, MGC, and MG-QoL15 were ≤7, 2, 3, and 8 points, respectively.ConclusionsWe have estimated thresholds for commonly used myasthenia health scales reflecting patient-acceptable states in patients with MG. These thresholds indicate a global state of well being, rather than a change in scores, or being better. Therefore, PASS thresholds can be used as secondary endpoints for myasthenia research.
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Harris L, Aban IB, Xin H, Cutter G. Employment in refractory myasthenia gravis: A Myasthenia Gravis Foundation of America Registry analysis. Muscle Nerve 2019; 60:700-706. [PMID: 31478207 PMCID: PMC6900169 DOI: 10.1002/mus.26694] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 08/28/2019] [Accepted: 08/28/2019] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Labor-market participation is potentially very difficult for patients with refractory myasthenia gravis (MG). In this study, employment status and work absences are compared between refractory and nonrefractory MG. METHODS Adults (aged 18-64 years, all diagnosed ≥2 years previously) were included if enrolled in the Myasthenia Gravis Foundation of America Patient Registry during July 2013 to February 2018. RESULTS Seventy-six patients (9.2%) had refractory and 749 (90.8%) had nonrefractory disease; demographic data did not differ between groups. Relative to the nonrefractory group, the refractory group patients were more than twice as likely to work fewer hours per week (odds ratio [95% confidence interval]: currently employed, 2.777 [1.640-4.704]; employed over previous 6 months, 2.643 [1.595-4.380]), but those employed were not more likely to be absent from work. DISCUSSION Because absence from the labor market adversely affects quality of life and personal finances, these findings reaffirm the considerable disease burden associated with refractory MG.
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Affiliation(s)
- Linda Harris
- Formerly of Alexion Pharmaceuticals, Inc., Boston, Massachusetts
| | - Inmaculada B Aban
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Haichang Xin
- Formerly of the Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
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Cutter G, Xin H, Aban I, Burns TM, Allman PH, Farzaneh-Far R, Duda PW, Kaminski HJ. Cross-sectional analysis of the Myasthenia Gravis Patient Registry: Disability and treatment. Muscle Nerve 2019; 60:707-715. [PMID: 31487038 PMCID: PMC6899582 DOI: 10.1002/mus.26695] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 08/05/2019] [Accepted: 08/30/2019] [Indexed: 12/11/2022]
Abstract
Introduction The Myasthenia Gravis Patient Registry (MGR) is a voluntary, patient‐submitted database dedicated to improve understanding of care/burden of myasthenia gravis (MG). Methods In this study we present analyses of baseline records through July 2017 (n = 1140) containing data on the MG—Activities of Daily Living (MG‐ADL) and the MG 15‐item Quality of Life (MG‐QOL15) instruments, two validated scales assessing quality of life in MG patients at sign‐up into the MGR. Results Most registrants reported moderate to severe impairment of health‐related quality of life, with a median MG‐ADL score of 6 and a median MG‐QOL15 score of 21. Seventy‐one percent of the patients had received pyridostigmine. Corticosteroids, mycophenolate mofetil, and azathioprine were the most common immunomodulators/immunosuppressants, with 85% of participants having ever using one of these agents. Forty‐seven registrants reported receiving intravenous immunoglobulin, and 30% received plasma exchange. Twelve percent reported other treatments, and 40% were unsure whether they received less common therapies. Forty percent had undergone thymectomy. Discussion The MGR data correlate well with other MG cohorts. Many MG patients remain negatively impacted despite treatment.
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Affiliation(s)
- Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Haichang Xin
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Inmaculada Aban
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ted M Burns
- Department of Neurology, University of Virginia, Charlottesville, Virginia
| | - Phillip H Allman
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ramin Farzaneh-Far
- Department of Clinical Research, Ra Pharmaceuticals, Inc., Cambridge, Massachusetts
| | - Petra W Duda
- Department of Clinical Research, Ra Pharmaceuticals, Inc., Cambridge, Massachusetts
| | - Henry J Kaminski
- Department of Neurology, George Washington University, Washington, DC
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Bogdan A, Barnett C, Ali A, AlQwaifly M, Abraham A, Mannan S, Ng E, Bril V. Chronic stress, depression and personality type in patients with myasthenia gravis. Eur J Neurol 2019; 27:204-209. [PMID: 31408565 DOI: 10.1111/ene.14057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/05/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Stress is a known risk factor for the onset and modulation of disease activity in autoimmune disorders. The aim of this cross-sectional study was to determine any associations between myasthenia gravis (MG) severity and chronic stress, depression and personality type. METHODS In all, 179 consecutive adult patients with confirmed MG attending the Neuromuscular Clinic between March 2017 and December 2017 were included. At baseline, patients were assessed clinically and they completed self-administered scales for disease severity, perceived stress, depression and personality type. RESULTS Higher disease severity [Myasthenia Gravis Impairment Index (MGII)] showed a moderate correlation with depression score (Beck's Depression Inventory, Second Edition, r = 0.52, P < 0.001) and a lower correlation with chronic stress (Trier Inventory for Assessment of Chronic Stress, r = 0.28, P = 0.001). Chronic stress scores were different according to personality types (anova, P = 0.02). The linear regression model with MGII score as the dependent variable showed R2 = 0.34, likelihood ratio chi-squared 74.55, with P < 0.0001. The only variables that predicted disease severity were depression scores (P < 0.0001) and female sex (P = 0.003). CONCLUSIONS A significant association of MG severity with depression and chronic stress was found, as well as with female gender. These findings should raise awareness that the long-term management of MG should address depression and potential stress and consider behavioural management to prevent stress-related immune imbalance.
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Affiliation(s)
- A Bogdan
- Division of Neurology, Department of Medicine, Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto, Toronto, ON, Canada
| | - C Barnett
- Division of Neurology, Department of Medicine, Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - A Ali
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - M AlQwaifly
- College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - A Abraham
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Mannan
- Division of Neurology, Department of Medicine, Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto, Toronto, ON, Canada
| | - E Ng
- Division of Neurology, Department of Medicine, Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto, Toronto, ON, Canada
| | - V Bril
- Division of Neurology, Department of Medicine, Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto, Toronto, ON, Canada
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Xin H, Harris LA, Aban IB, Cutter G. Examining the Impact of Refractory Myasthenia Gravis on Healthcare Resource Utilization in the United States: Analysis of a Myasthenia Gravis Foundation of America Patient Registry Sample. J Clin Neurol 2019; 15:376-385. [PMID: 31286711 PMCID: PMC6620464 DOI: 10.3988/jcn.2019.15.3.376] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose Patients with refractory myasthenia gravis (MG) experience ongoing disease burden that might be reflected in their healthcare utilization. Here we examine the impact of refractory MG on healthcare utilization. Methods The 825 included participants were aged 18–64 years, enrolled in the Myasthenia Gravis Foundation of America Patient Registry between July 2013 and February 2018, and had been diagnosed with MG ≥2 years previously. Results Participants comprised 76 (9.2%) with refractory MG and 749 (90.8%) with nonrefractory MG. During the 6 months before enrollment, participants with refractory MG were significantly more likely than those with nonrefractory MG to have experienced at least one exacerbation [67.1% vs. 52.0%, respectively, p=0.01; odds ratio (OR)=1.882, 95% confidence interval (CI)=1.141–3.104], visited an emergency room at least once [43.4% vs. 27.1%, p<0.01; OR=2.065, 95% CI=1.276–3.343], been hospitalized overnight at least once (32.9% vs. 20.5%, p=0.01; OR=1.900, 95% CI=1.140–3.165), ever been admitted to an intensive care unit (ICU) (61.8% vs. 33.4%, p<0.01; OR=3.233, 95% CI=1.985–5.266), or ever required a feeding tube (21.1% vs. 9.1%, p<0.01; OR=2.671, 95% CI=1.457–4.896). A total of 75.8% younger females with refractory disease (<51 years, n=33) experienced at least one exacerbation, 69.7% had been admitted to an ICU, and 30.3% had required a feeding tube. For older females with refractory disease (≥51 years, n=33), 60.6%, 54.6%, and 6.1% experienced these outcomes, respectively (between-group differences were not significant). Conclusions Refractory MG is associated with higher disease burden and healthcare utilization than nonrefractory MG.
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Affiliation(s)
- Haichang Xin
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Inmaculada B Aban
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
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Lee I, Kaminski HJ, McPherson T, Feese M, Cutter G. Gender differences in prednisone adverse effects: Survey result from the MG registry. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 5:e507. [PMID: 30345333 PMCID: PMC6192695 DOI: 10.1212/nxi.0000000000000507] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/07/2018] [Indexed: 11/15/2022]
Abstract
Objective Prednisone is a first-line immunosuppressive treatment for myasthenia gravis (MG), whereas short-term and long-term adverse effects (AEs) are a limiting factor in its usage. Method The MG patient registry is a patient-driven, nation-wide database with patients of age ≥18 years, who were diagnosed with MG and live in the United States. Custom-designed "prednisone-steroid use and MG" survey was sent out to MG registry participants as part of semi-annual follow-up. Data were collected and analyzed for frequency. Results A total of 398 MG participants (21% response rate) completed the survey, including 173 men and 225 women. Among them, 298 reported current (174) or past (288) prednisone intake. Current prednisone dosage varied from 0.5 to 75 mg (median 10 mg, IQR 7-20), dosing frequency was daily in 132 (76%) and every other day in 31 (18%). Peak prednisone dose was commonly between 25 mg and 60 mg (Median 50 mg, IQR 25-60); however, doses more than 60 mg daily were reported in 59 (20%). Prednisone AEs were reported more commonly in women (95% vs 81%, p < 0.0001). Women reported more intolerable AEs (77% vs 50%, p < 0.00001) and less willingness to accept a dose increase (26% vs 44%, p = 0.03) compared with men. Conclusions Prednisone is commonly used in the treatment of MG, with highly variable dosages and dosing frequencies reflecting the absence of a standard guideline. Intolerable AEs were more commonly reported among women and was associated with unwillingness to accept a dose increase. Consensus guidelines and their validation are required to guide prednisone treatment for MG.
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Affiliation(s)
- Ikjae Lee
- Department of Neurology (I.L.), University of Alabama, Birmingham; Department of Neurology (H.J.K.), the George Washington University; and Department of Biostatistics (T.M., M.F., G.C.), University of Alabama, Birmingham
| | - Henry J Kaminski
- Department of Neurology (I.L.), University of Alabama, Birmingham; Department of Neurology (H.J.K.), the George Washington University; and Department of Biostatistics (T.M., M.F., G.C.), University of Alabama, Birmingham
| | - Tarrant McPherson
- Department of Neurology (I.L.), University of Alabama, Birmingham; Department of Neurology (H.J.K.), the George Washington University; and Department of Biostatistics (T.M., M.F., G.C.), University of Alabama, Birmingham
| | - Michelle Feese
- Department of Neurology (I.L.), University of Alabama, Birmingham; Department of Neurology (H.J.K.), the George Washington University; and Department of Biostatistics (T.M., M.F., G.C.), University of Alabama, Birmingham
| | - Gary Cutter
- Department of Neurology (I.L.), University of Alabama, Birmingham; Department of Neurology (H.J.K.), the George Washington University; and Department of Biostatistics (T.M., M.F., G.C.), University of Alabama, Birmingham
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