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Abstract Details

Real-world Treatment Patterns, Discontinuation, and Treatment Switches in Patients With Generalized Myasthenia Gravis (gMG): A Retrospective Claims Analysis
Neuromuscular and Clinical Neurophysiology (EMG)
P4 - Poster Session 4 (8:00 AM-9:00 AM)
9-003
To describe real-world treatment patterns, discontinuation, and treatment switching among a prevalent cohort of patients with generalized myasthenia gravis (gMG) in the United States.
gMG is a chronic autoimmune disorder associated with fluctuating muscle weakness. Understanding treatment patterns, including steroid use and therapy switching, is essential to identify unmet needs in clinical practice.
This retrospective cohort study used administrative claims from the MORE2 Registry® and Medicare Fee-for-Service (2018–2024). Eligible patients were ≥18 years old with ≥1 inpatient or ≥2 outpatient claims for gMG and ≥12 months of continuous enrollment before and after index; ocular MG was excluded. Outcomes assessed included treatment patterns during the variable-length follow-up period.
Among 44,525 patients with prevalent gMG, oral corticosteroids (48%) were the most common therapy, followed by non-steroidal IST (25%). Biologic use was low (6%), with rituximab, eculizumab, and efgartigimod most frequently prescribed. Monotherapy predominated (57%), while 16% received combination regimens. Prednisone-equivalent dosing showed substantial exposure: 22% received ≥20 mg/day, 17% 10–<20 mg/day, 7% 5–<10 mg/day, and 2% >0–≤5 mg/day. The mean duration of the first treatment was 292 days. Regimen termination most often reflected discontinuation (61%), followed by stacking/add-on therapy (15%) and switching (9%). Notably, 35% of patients had treatment sequences that involved repeated courses of steroids separated by ≥60-day gaps. Illustrating how discontinuation often represented cycling back to corticosteroids rather than durable regimen change. These patterns highlight frequent interruptions in care, recurrent steroid cycling, and limited progression to biologics, consistent with payer-driven step therapy and barriers to biologic initiation.
In this large real-world cohort, treatment of gMG remains dominated by steroids, with low biologic uptake and frequent discontinuation. High reliance on corticosteroid monotherapy and repeated cycling highlight persistent unmet need in managing gMG, underscoring the importance of expanding access to effective targeted therapies.
Authors/Disclosures
Seth Anderson, PharmD
PRESENTER 		Dr. Anderson has received personal compensation for serving as an employee of Amgen. Dr. Anderson has or had stock in Amgen.
James F. Howard, Jr., MD, FAAN (The University of North Carolina, Dept of Neurology, CB 7025) Dr. Howard has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for argenx . Dr. Howard has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Regeneron Pharmaceuticals. Dr. Howard has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Howard has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AMGEN (Horizon Therapeutics). Dr. Howard has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Howard has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biohaven Ltd. Dr. Howard has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for CorEvitas. Dr. Howard has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck EMD Serono. Dr. Howard has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cartesian Therapeutics. Dr. Howard has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NMD Pharma. Dr. Howard has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for H. Lundbeck A/S. Dr. Howard has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Seismic Therapeutics. Dr. Howard has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB Pharma. Dr. Howard has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vor Biopharma. Dr. Howard has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Academic CME. Dr. Howard has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for PeerView CME. Dr. Howard has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Platform Q CME. Dr. Howard has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for MJH LifeSci. Dr. Howard has or had stock in Johnson & Johnson dividends.Dr. Howard has or had stock in Pfizer dividends. An immediate family member of Dr. Howard has or had stock in GlaxoSmithKline dividends.Dr. Howard has or had stock in Bristol Myer Squbb dividends.Dr. Howard has or had stock in AbbieVie Inc. The institution of Dr. Howard has received research support from Alexion Pharmaceuticals. The institution of Dr. Howard has received research support from argenx . The institution of Dr. Howard has received research support from UCB Biosciences. The institution of Dr. Howard has received research support from NIH. The institution of Dr. Howard has received research support from Centers for Disease Control/Research Triangle Institute. The institution of Dr. Howard has received research support from Cartestian Therapeutics. The institution of Dr. Howard has received research support from NMD Pharma. The institution of Dr. Howard has received research support from Ad Scientiam. The institution of Dr. Howard has received research support from Merck EMD Serono. Dr. Howard has a non-compensated relationship as a Scientific Advisiory Board member, Committee member with Myasthenia Gravis Foundation of America that is relevant to AAN interests or activities. Dr. Howard has a non-compensated relationship as a Committee member with American Assoc Neuromuscular and Electrodiagnostic Medicine that is relevant to AAN interests or activities.
Joseph Tkacz The institution of Mr. Tkacz has received research support from Amgen.
Rebecca Wilson, MDiv Ms. Wilson has nothing to disclose.
Jill Schinkel The institution of Jill Schinkel has received research support from Amgen.
Dustin Cavida (Amgen) Mr. Cavida has received personal compensation for serving as an employee of Amgen. Mr. Cavida has stock in Amgen.
Blanca Canales, PharmD Dr. Canales has received personal compensation for serving as an employee of Amgen. Dr. Canales has stock in Amgen .
Kristina R. Patterson, MD, PhD (Horizon Therapeutics) Dr. Patterson has received personal compensation for serving as an employee of Amgen. Dr. Patterson has stock in Amgen.