Researchers identified specific factors that predict whether patients with myasthenia gravis (MG) are more likely to experience myasthenic crises and disease exacerbations. The study, published in the Journal of Neuroinflammation, assessed a cohort of 815 patients with MG, aiming to identify specific risk factors for myasthenic crises and disease exacerbations.

“Prognostic factors identifying patients at risk for [myasthenic crises] or disease exacerbations remain incompletely understood and have only been characterized for MG patients presenting with a thymoma,” the authors explained.

“Disease severity at diagnosis (quantitative MG score or Myasthenia Gravis Foundation of America class), the presence of thymoma, and anti-muscle specific tyrosine kinase-antibodies were independent predictors of [myasthenic crisis] or disease exacerbation.”

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Patients with MG experience a significant burden from myasthenic crises and exacerbations due to their significant lethality. The research team found that patients with fewer disease manifestations 1 year after diagnosis were at a lower risk of myasthenic crises and exacerbations than those with greater disease severity at 1 year.

Patients with poorer outcomes were generally older, had a lower vital capacity and a higher Myasthenia Gravis Foundation of America class before myasthenic crises and at hospital admission, and had more comorbidities. Furthermore, patients requiring intubation or prolonged mechanical ventilation and those with myasthenic crises due to infection experienced poorer outcomes than those without these risk factors.

The time delay between diagnosis and the initiation of immunosuppressive therapy had no effect on these risks, nor did the use of intravenous immunoglobulin treatment, plasma exchange, or a combination of the two. The authors recommend more intensive monitoring of patients with MG, with special consideration toward the prevention of infectious complications to reduce the risk of uncontrolled disease in these individuals.

Reference

Nelke C, Stascheit F, Eckert C, et al. Independent risk factors for myasthenic crisis and disease exacerbation in a retrospective cohort of myasthenia gravis patients. J Neuroinflammation. 2022;19(1):89. doi:10.1186/s12974-022-02448-4