Patients with myasthenia gravis (MG) confirm that disease severity greatly impacts their health-related quality of life (HRQoL), according to a study recently published in BMJ Journals.

“In this real-world study with a large and diverse MG population and different PROM instruments, a consistent and large impact of MG on HRQoL aspects such as usual activities, depression, tiredness, breathing and vision was observed despite the best supportive care,” the authors wrote.

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This longitudinal, prospective, observational study used real-world data collected from patients previously diagnosed with MG. A total of 834 participants self-reported their medical history and clinical course on a mobile application called MyRealWorld-MG. Most (70%) of the individuals were females, and the mean age was 47 years.

The majority (38.1%) had moderate generalized MG Foundation of America (MGFA) class 3, followed by mild generalized MGFA class 2 (31%), ocular MGFA class 1 (13.9%), and severe MGFA class 5 (1.6%). All patients were currently receiving treatment, most of them including pyridostigmine, almost half steroids, some of them azathioprine, and only 20% underwent plasma exchange or immunoglobulin administration.

As expected, the MGFA classification was, on its own, an important factor that influenced all items of HRQoL. The MG Activities of Daily Living (MG-ADL) score further correlated with the MGFA class, with 2.7, 4.4, 6.3, and 8.4 points for the 1, 2, 3, and 4 classes, respectively.

Likewise, patients scored lower as the MGFA class increased in the EuroQol 5 Domains Health-Related Quality of Life Questionnaire (EQ-5D-5L), with scores of 0.817, 0.766, 0.648, and 0.530, for each 1 to 4 MGFA class, respectively. The most commonly reported problems were daily activities, tiredness, breathing, vision, anxiety, and depression.

Although these results are not surprising, it is important to acknowledge the prominent impact of the disease severity related to MGFA classification on the decrease in the HRQoL, the researchers noted.

“Only our publication reported HRQoL across the different MGFA classes, whereas other publications reported results by refractory versus non-refractory patients with MG or by MG subtype,” the authors highlighted.


Dewilde S, Philips G, Paci S. Patient-reported burden of myasthenia gravis: baseline results of the international prospective, observational, longitudinal real-world digital study MyRealWorld-MG. BMJ. Published online January 31, 2023. doi:10.1136/bmjopen-2022-066445