Abstract Details

Title Effects of Medication Adjustment on Myasthenia Gravis Patients and Time to Readmission in an Academic Center

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 1-008

Objective We determine the effect of medications on admission/discharge to readmission/readmission rate in hospitalized myasthenia gravis (MG) patients.

Background The heterogeneity of MG and limited randomized-control trials for treatments render post-discharge management challenging. Previous studies explored readmission rates and associated factors, but none examined medications at index hospitalization vs. discharge. Despite available guidelines and an international consensus, therapeutic strategies still vary greatly.

Design/Methods Thomas Jefferson University EMR was queried from 04/2017-04/2019 for admitted patients with ICD-10 codes G70.00/G70.01. Thirty-three patients were identified, and treatment profiles obtained (prednisone, mycophenolate, azathioprine, IVIg/PLEX at admission and discharge). Unpaired t and chi-squared/Fisher’s exact tests on treatment type on admission/discharge and time to readmission/readmission rate were performed. We developed a Discharge Score to help predict readmission risk. Points were given for therapies on admission/discharge: prednisone 1 point, mycophenolate/azathioprine 1.5 points, and IVIg/PLEX 2 points, and added/subtracted based on dose adjustments (prednisone 0.5 points and mycophenolate/azathioprine 1 point) with a score range of -2.5 to 6.

Results Prednisone on admission did not significantly lengthen time to readmission (p=0.61). However, mycophenolate on admission significantly lengthened time to readmission (p=0.03; 113.7 days). Readmission rate was not significantly decreased if discharged on prednisone (p=0.95), azathioprine (p=1.00), or IVIg/PLEX (p=0.16), but there was a trend towards significance if not discharged on mycophenolate (p=0.06). Readmission rate was significantly decreased when IVIg/PLEX therapies were added/continued with no other changes (p=0.03). A score less than 3 was seen in 21 patients and was significant in determining likelihood for readmission (p=0.04).

Conclusions Efficacy of slow-acting immunosuppressants has not been established as a first-line therapy in steroid-naïve MG patients. Our data suggests that introduction of mycophenolate upon discharge may prevent or lengthen time to readmission. Individualized plan for post-discharge continuation of IVIg/PLEX with no other changes may also decrease the readmission rate.

Authors/Disclosures
Connie G. Tang, MD (Lehigh Valley Health Network) PRESENTER	Dr. Tang has nothing to disclose.
Nathanael Lee, MD (Thomas Jefferson University)	No disclosure on file
Mina Youn, MD	Dr. Youn has nothing to disclose.
Goran Rakocevic, MD, FAAN (Thomas Jefferson University)	Dr. Rakocevic has nothing to disclose.

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