More severe MG linked to exacerbation, healthcare use: Study
Personalized treatment for patients may ease burden on healthcare resources
People with more severe myasthenia gravis (MG) have a greater likelihood of experiencing episodes of exacerbation, when symptoms worsen or reappear, and may need more medical care, according to the findings of a new study.
The study also suggested that personalized treatment for these MG patients may ease the burden on healthcare resources.
“Having more severe MG symptoms increased the risk of exacerbation. Healthcare services were needed in about 50% of exacerbation cases,” the researchers wrote.
Further, the team found that using the long-established MG-ADL scale — fully known as the MG Activities of Daily Living — in routine clinical practice in a real-world setting may provide insights into the likely course of the disease and inform treatment decisions.
The study, “Risk of Exacerbation and Level of Healthcare Resource Utilization in Myasthenia Gravis Assessed by Myasthenia Gravis Activities of Daily Living Score,” was published in the journal Neurology and Therapy. The work was funded by UCB, Atlanta, and three of the seven authors work for the biopharma company.
Investigating the utility of the MG-ADL in patient clinical care
MG is an autoimmune disease that occurs when the body’s immune system mistakenly attacks proteins required for the communication between nerves and muscles involved in voluntary movements. This causes those muscles to become weak and easily fatigued.
Patients sometimes will experience an exacerbation, when existing symptoms worsen or new ones appear. An exacerbation can make it difficult to do everyday activities and may require hospital care. However, not much is known about how often patients use healthcare services when going through an exacerbation.
The MG-ADL scale is a questionnaire with eight queries that help evaluate the impact MG symptoms have on everyday activities, such as talking, eating, and breathing. Patients usually fill it out themselves, and doctors use it in clinical trials to track how the disease is responding to treatment.
However, according to the researchers, “despite the clinical relevance of MG-ADL score to the patient’s disease, there are limited data on the relationship between MG-ADL score and risk of MG exacerbation.”
To learn more, the team launched a study that drew on data from the MG Foundation of America Global MG Patient Registry, known as MGFAPR. In this ongoing database, funded by the MG Foundation of America, adults living with the disease can fill out questionnaires and share details about their experiences. The researchers noted that the patients in their study “were based in the USA” and enrolled in the registry between July 2013 and September 2022.
“The objective of this retrospective, cross-sectional, observational study was to assess the patient characteristics, the exacerbation risk in relation to MG-ADL score, and the level of [healthcare resource utilization] following exacerbation using data from the MGFAPR,” the researchers wrote.
Of the 3,416 patients in the study, slightly more than half (61.2%) were women. All were diagnosed with MG at a mean age of 49.4. Those with more severe MG, defined as an MG-ADL score higher than seven, were more likely to be women, younger at the time of diagnosis, Black individuals, unemployed, or without private health insurance.
“There were social, economic, and racial differences between people with more severe MG compared with those with less severe MG,” the researchers wrote. Such differences “highlight socioeconomic disparities in disease severity, which warrant additional research on racial and social inequities in healthcare access,” the team noted.
Study confirms link between more severe disease and exacerbations
In this study, patients with more severe MG were also more likely to have other health problems, known as comorbidities. Among the coexisting health issues noted were depression, anxiety, chronic obstructive pulmonary disease, osteoporosis, asthma, and other autoimmune diseases, such as lupus.
At the time of entry in the registry, the median MG‐ADL score was six, and as many as 45% of patients — 1,543 in total — had experienced an exacerbation within the previous six months. Here, an exacerbation was defined as having longer than seven days of symptom worsening or new symptoms, with at least 30 days since the last exacerbation.
The proportion of patients with more severe MG who had an exacerbation was nearly twice that of those who scored seven points or fewer in the MG‐ADL scale (62.6% vs. 34.5%). For patients scoring 14 points or higher, the proportion was even greater (78.4%).
To our knowledge, this is the first study in a real-world setting to confirm that greater MG severity is associated with increased exacerbation risk and levels of [healthcare resource utilization]. … Insurance and healthcare providers may need to take a personalized approach to patient management and identify patients at risk of exacerbations who require additional support.
For each additional point in the MG-ADL score, the exacerbation rate increased by 13%. This means that patients with more severe symptoms were more likely to have these episodes, with about half needing medical care, such as hospitalization or treatment.
Of the 1,751 patients who completed the first follow-up questionnaire at six months, 331 (19%) reported an exacerbation. Slightly more than half of these patients (54%) required overnight hospitalization or treatment following their exacerbation.
“To our knowledge, this is the first study in a real-world setting to confirm that greater MG severity is associated with increased exacerbation risk and levels of [healthcare resource utilization],” the researchers wrote.
The scientists suggested that finding better ways to treat MG, and improving access to healthcare, might help reduce the number of exacerbation episodes — especially for patients with more severe disease — and ease the burden on healthcare resources.
Better treatment plans may include “faster-acting therapeutics and personalized approaches to management, especially for patients with comorbidities, and the socio-demographic groups at risk of increased disease severity,” the researchers wrote, adding that “insurance and healthcare providers may need to take a personalized approach to patient management and identify patients at risk of exacerbations who require additional support.”
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