In England, disease burden is high for newly diagnosed MG patients
Over half of patients had at least 1 MG-related hospitalization, study finds
People newly diagnosed with myasthenia gravis (MG) in England experience a high disease burden, with about two-thirds having at least one exacerbation, or an episode of disease worsening, and approximately half having one MG-related hospitalization.
That’s according to a new study led by researchers from the pharmaceutical company UCB, who noted that “greater awareness of the clinical burden experienced by patients with newly diagnosed MG … may help to improve treatment strategies and management of this population.”
The researchers also analyzed the impact of MG on the use of healthcare resources in the country by individuals newly diagnosed with the disease. About 10% of patients were admitted to intensive care due to MG-related complications, the data showed.
“These data confirm the high disease burden and [healthcare resource utilization] of patients in England with newly diagnosed MG and highlight the limitations of conventional treatments, including increased infection risk and inadequate symptom control,” the researchers wrote.
According to the team, “there is a need for targeted treatments with sustained efficacy and improved safety to adequately manage MG symptoms and reduce MG-related disease burden.”
The study, “Disease burden, healthcare resource utilisation, and treatment patterns in patients with newly diagnosed myasthenia gravis in England: A retrospective cohort study,” was published in the Journal of Neuromuscular Diseases. UCB funded the work. The company markets Rystiggo (rozanolixizumab-noli) and Zilbrysq (zilucoplan), both approved treatments for people with MG.
Investigating MG disease burden in newly diagnosed patients
MG is an autoimmune disease caused by self-reactive antibodies that mistakenly attack proteins at the neuromuscular junction — the site where nerve and muscle cells communicate to coordinate voluntary movements. It results in muscle weakness and fatigue.
The disease is associated with several co-occurring conditions and a high burden linked to the use of healthcare resources, decreased quality of life, and mental health issues.
“The years immediately following MG diagnosis are typically a period of high healthcare resource [utilization], especially in the first year after diagnosis whereby emergency room visits, [hospitalizations], and intensive care unit … admissions are all high,” the researchers wrote. “However, to our knowledge, there are no published data specifically for patients newly diagnosed with MG.”
To learn more, the team retrospectively analyzed the electronic medical records of 480 individuals newly diagnosed with MG in England and 2,237 age- and sex-matched people without MG, who served as controls.
About 57% of the patients were men, with a mean age of 67.4 at the time of diagnosis. Following their diagnosis, the patients were followed for a mean time of 2.8 years.
Before and after diagnosis, those with MG had a higher incidence of co-occurring conditions, known as comorbidities, than the controls. Among the conditions seen in the MG patients were infections, high blood pressure, diabetes, abnormal levels of fatty molecules in the blood, and obesity.
Nearly two-thirds of the MG patients (63.5%) had at least one disease exacerbation during follow-up. Exacerbations were defined as an episode of symptom worsening requiring hospitalization or treatment with intravenous immunoglobulin or plasma exchange, a blood-cleaning procedure. A mean of 2.6 exacerbations occurred per patient.
Myasthenic crisis, defined as admission to an intensive care unit combined with respiratory failure or mechanical ventilation or intubation, was reported in 17 patients (3.5%), with a mean of 1.3 crises occurring per patient.
“In our study, the proportion of patients with MG who required [intensive care unit] admission was three times higher than the proportion of patients who experienced myasthenic crises,” the researchers wrote, noting that “ruled out crises as the prominent cause of overnight [hospitalization].”
1 in 10 patients admitted to intensive care due to MG complications
The researchers then analyzed healthcare resource utilization. They found that a slightly higher proportion of MG patients than controls — 99.8% versus 96.4% — visited a specialist at least once. The difference was markedly greater for neurology specialist appointments, with 77.1% of MG patients having at least one such visit compared with 5.6% of the controls.
Outpatient care visits (98.1% vs. 82.4%), hospitalizations (65% vs. 33.2%), and intensive care admissions (12.5% vs. 1.8%) also were seen more frequently in MG patients than in controls, the data showed.
Slightly more than half of patients (51.3%) had at least one MG-related hospitalization, and 9.6% were admitted to intensive care at least once due to MG.
Our data highlight the compelling need for improved treatments for MG. Specifically, more effective, targeted treatments with sustained efficacy and improved safety to adequately manage MG symptoms and reduce MG-related disease burden.
In the first year after diagnosis, more than half of the patients were treated with corticosteroids (50.2%) and acetylcholinesterase inhibitors (56%).
During follow-up, the use of acetylcholinesterase inhibitors progressively decreased, while that of corticosteroids increased. Altogether, 3 of every 10 patients (29.6%) were treated with nonsteroidal immunosuppressive medications, mainly azathioprine (22.9%), while 10.2% received intravenous immunoglobulin and 3.1% required plasma exchange.
Surgical removal of the thymus, an organ of the immune system thought to play a role in MG, was the treatment for 5.4% of patients.
Overall, the researchers concluded that patients with newly diagnosed MG in England have a substantial disease burden, “with high rates of MG exacerbation and … use” of healthcare resources.
“Our data highlight the compelling need for improved treatments for MG. Specifically, more effective, targeted treatments with sustained efficacy and improved safety to adequately manage MG symptoms and reduce MG-related disease burden,” the researchers wrote.
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