To summarize evidence on the effectiveness of Remission (R), minimal manifestations (MM), Slight Improvement (SI), and Patient-Acceptable Symptom State (PASS) as therapeutic goals in Myasthenia Gravis (MG).

We systematically searched PubMed, Scopus, and CENTRAL (till August 2025) for studies comparing outcomes in MG patients achieving R, MM, SI, or PASS. Random-effects models estimated pooled effects; heterogeneity was assessed with I². Risk of bias was evaluated using the Newcastle-Ottawa scale and certainty with GRADE.

Nine studies (5 cohort, 4 cross-sectional; 6,165 patients) were included. Compared to R, achieving MM was linked to worse MG-QoL-15 (MD 2.70; 95% CI: 1.61–3.79; I² = 87%), MG-ADL (MD 0.70; 95% CI: 0.19–1.21; I² = 90%), and QMG (MD 2.46; 95% CI: 1.39–3.52; I² = 72%). Versus SI, MM reduced myasthenic crisis risk (OR 0.32; 95% CI: 0.17–0.61) and QMG scores (MD –4.68; 95% CI: –6.36 to –3.00; I² = 91%). Compared to R, SI worsened MG-QoL-15 (MD 6.60; 95% CI: 3.85–9.35; I² = 92%), MG-ADL (MD 3.10; 95% CI: 0.38–5.82; I² = 85%), and QMG (MD 7.36; 95% CI: 6.72–7.99; I² = 0%). Achieving PASS improved MG-QoL-15 (MD –12.18; 95% CI: –18.73 to –5.64; I² = 90%), MG-ADL (MD –4.07; 95% CI: –5.93 to –2.22; I² = 88%), and QMG (MD –6.65; 95% CI: –7.53 to –5.78; I² = 0%). . Risk of bias was low–moderate (cohorts) and moderate–high (cross-sectional). Certainty of evidence was very low across outcomes.

Achieving MM or R in MG may improve quality of life, function, and symptoms, with very low certainty. MM generally showed worse outcomes than R. PASS appears promising as a treatment goal. Higher-quality studies are needed to confirm these results and guide recommendations.