Efficacy prioritized in treatment of generalized myasthenia gravis
Study in Spain analyzed preferences of nearly 150 neurologists
Neurologists consider the degree of clinical efficacy and the onset of action as the most important factors when making treatment decisions for their patients with generalized myasthenia gravis (gMG), according to a study.
Still, there is variability, with some physicians considering the mode of treatment administration a more important factor than others. Physicians’ personality traits were found to influence what aspects of care they valued most.
“Our findings suggest that neurologists treating gMG increasingly prioritize rapid, clinically meaningful symptom control, reflecting the capabilities of new targeted therapies,” researchers wrote.
As these new treatments alter the MG care landscape, “integrating patient preferences, minimizing treatment burden, and supporting shared decision-making will be critical to ensuring effective implementation in daily clinical practice,” they added.
The study, “Treatment Preferences of Neurologists in Generalized Myasthenia Gravis: A Conjoint Analysis Study,” was published in Neurology and Therapy. It was funded by Roche, with which four study authors are affiliated.
Physicians facing more complex treatment decisions
Myasthenia gravis (MG) is an autoimmune disease in which the immune system mistakenly attacks proteins important for nerve-muscle communication, leading to muscle weakness and fatigue. In gMG, this weakness can occur in different muscle groups throughout the body.
Treatment for gMG aims to ease symptoms and make daily activities easier. Broad-acting immunosuppressants, which used to be the only option, can have variable efficacy and substantial side effects, according to the scientists.
More recently, several targeted therapies, including complement inhibitors and FcRn blockers, have become available. These medications, with more precise mechanisms, are intended to work faster, better, and with a favorable safety profile.
With several options now available, physicians face more complex treatment decisions. Understanding how neurologists make these choices “is critical for ensuring that clinical strategies align both evidence and patient-centered outcomes,” the researchers wrote.
Scientists in Spain set out to learn more about neurologists’ treatment preferences for gMG patients with antibodies against the acetylcholine receptor, the most common type of MG-causing antibody.
A total of 149 neurologists, with a mean of nearly 10 years of experience in MG treatment, participated in the web-based study.
In addition to completing a range of personality and behavior questionnaires, the participants were presented with eight hypothetical gMG treatment scenarios and were asked to rank them from most to least preferred. According to the authors, the scenarios were designed to reflect the complexities of making treatment choices in real-world clinical settings.
The researchers analyzed the following preferences to determine which attributes of care were considered most important when making treatment decisions: the degree of clinical improvement, the onset of action, how long the effects last, adverse events, and the route/frequency of administration.
Behavioral, personality traits appeared to influence treatment preferences
Responses indicated that the intensity of clinical improvement was the most influential factor, with a relative importance of 38.6%. This was followed by the onset of action (21.5%), duration of effect (17.4%), adverse events (14.3%), and route/frequency of administration (8.1%).
“This emphasis on efficacy is consistent with findings in other chronic neuroimmunologic conditions where relapse rate, disability progression, or symptom burden significantly impacts daily life,” the researchers wrote. “This suggests a common underlying principle in neurology: clinicians prioritize treatments that offer clear, measurable clinical benefit and disease control.”
Still, findings at the individual level were variable. A subset of neurologists felt that the route and frequency of administration were just as important as how quickly the medication took effect. Some gMG therapies require infusions into the bloodstream at a clinic, while others can be given via an under-the-skin, or subcutaneous, injection at home.
The researchers believe this “highlights the critical need for individualized treatment approaches.” They noted that physicians should actively engage with their patients to determine their preferences for treatment administration.
These findings underscore that objective clinical data do not solely drive physician decision-making but are also shaped by individual … characteristics.
Responses were generally similar between neurologists who were or were not neuromuscular specialists. However, other behavioral and personality traits appeared to influence treatment preferences.
Neurologists who scored higher in conscientiousness found sustained treatment efficacy important. On the other hand, doctors with lower empathy scores placed greater weight on the route and frequency of administration.
“These findings underscore that objective clinical data do not solely drive physician decision-making but are also shaped by individual … characteristics,” the researchers wrote.
The scientists noted that the analysis was limited by the fact that medication cost, which can heavily influence treatment choices, was not included as an attribute. The participants also mostly worked in academic hospitals, and the data may not be generalizable to other types of practices.
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