[Pubmed] Insufficient immunosuppressive treatment in patients with myasthenia gravis in the context of the possibility o

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Neurol Neurochir Pol. 2026 Apr 14. doi: 10.5603/pjnns.107882. Online ahead of print.

ABSTRACT

AIM OF THE STUDY: The authors aimed to characterize the population with myasthenia gravis (MG), focusing on their eligibility for a therapeutic program with terminal complement protein C5 inhibition (ravulizumab), neonatal Fc receptor (FcRn) modulation (efgartigimod), and with anti-cluster of differentiation 20 (anti-CD20) monoclonal antibody rituximab reimbursed by the Polish National Health Fund (NFZ), and also to create a database with clinical and epidemiological details of a large MG population.

CLINICAL RATIONALE FOR THE STUDY: Myasthenia gravis is a rare, life-threatening autoimmune neurological disease and, as such, is usually treated with traditional immunosuppressants. The therapeutic program enables the use of advanced agents, but the eligibility criteria are highly restrictive. It is not known how many patients may be eligible for treatment with advanced therapies since the available data is sparse.

MATERIAL AND METHODS: The authors reviewed the clinical files of all 82 hospitalizations (of 65 patients) due to MG at the Department of Neurology of Poznan University Hospital between January 2023 and May 2025. Collected data included: age, gender, reason for admission, treatment before and after hospitalization with doses, The Myasthenia Gravis-Activities of Daily Living scale (MG-ADL), and Myasthenia Gravis Foundation of America (MGFA) scores on admission, treatment with intravenous immunoglobulin (IVIG)/plasmapheresis during hospitalization, data describing the autoimmunologic and comorbidities profile of each patient. Furthermore, the authors explored whether patients fulfilled the therapeutic program enrollment criteria: 1) history of glucocorticoids (GCS) therapy for at least 6 months (at least 3 months of 30 mg of prednisone daily); 2) history of using two drugs from the class of non-steroidal immunosuppressive drugs, including one for at least 12 months and the other for at least 6 months. Statistical analyses were conducted using JASP software (University of Amsterdam, the Netherlands).

RESULTS: Among 65 patients, the median age was 64 years, 57% were women, and 94% had at least one comorbidity. During 82 hospitalizations, the authors used IVIG 23 times, plasmapheresis 8 times, and a combination of these therapies 3 times. In only 6.1% of hospitalized patients, there was a proven history of adequate oral steroid therapy, and no patient fulfilled definitively the criterion for a history of treatment with two non-steroidal immunosuppressive drugs.

CONCLUSIONS AND CLINICAL IMPLICATIONS: Only a small percentage of patients are eligible for the therapeutic program as an indication of insufficient immunosuppressive treatment of MG before hospitalization.

PMID:41979428 | DOI:10.5603/pjnns.107882


Source: https://pubmed.ncbi.nlm.nih.gov/4197942 ... t6+133c1fe