What is MG?

gMG is a rare, chronic autoimmune neuromuscular disease of the NMJ, that may result in chronic impaired muscle function1-4

gMG is a rare, chronic autoimmune disease that targets the NMJ1
gMGis characterized by fluctuating and fatiguable skeletal muscle weakness1-4
gMGcan affect many muscle groups, including ocular, bulbar, limb, axial and respiratory muscles1-4

Prevalence and incidence of MG

The worldwide prevalence of MG is estimated to be between 80 and 278 per million 5-11

mg-prevalence
female
In young people, the incidence of MG is higher in women than in men6,8,9,15

Age at MG onset differs between

Women & Men

mg-prevalence

Manifestation of MG

ocular
MG often first manifests as weakness of ocular muscles22,23
ocular
In about three-quarters (75-80%) of patients with ocular MG, disease eventually generalizes to affect the face, neck, hands and/or limbs, and/or respiratory muscles23,24,25,26
mg-prevalence

Characterized by fluctuating and fatigable muscle weakness,often in the ocular muscles 27,30

In ~80%of patients, the disease generalizes

(gMG)to affect other muscles 31,32

aBased on a comprehensive survey in England to establish epidemiological data to examine patterns of clinical practice and disease phenotype from 100 cases of MG
bBased on a retrospective study of 1976 patients with MG between 1940 and 2000

Unpredictable gMG symptom fluctuations lead to a profound burden33,34

96% experienced symptom fluctuations33a In concept elicitation interviews conducted in 28 adult patients with gMG.

Fluctuations occur consistently and have a serious impact on QoL33,34a

1 / 2

Despite conventional therapy, 2 out of 3 patients experience gMG symptoms7b

Uncontrolled gMG can ultimately lead to clinical events such as life-threatening crises or exacerbations8

Fluctuations occur consistently and have a serious impact on QoL33,34a

A range of fluctuations33a
FatigueTrouble swallowingDifficulty breathingImpaired vision
Affecting well-being33,34a
PhysicalEmotionalSocialEconomic
Leading to lifestyle trade-offs34c
Work lifeFamily life

aResults from qualitative, cross-sectional, non-interventional study having semi-structured, in-depth concept elicitation interviews (N=28) conducted in the US with adult patients diagnosed with gMG.33

bResults of a questionnaire sent to 3262 members of the German Myasthenia Association who had myasthenia gravis (MG) (response rate of 52.5% [n=1660]) that reported various aspects of respondents' lives, including demographic data, educational status, employment, income, and level of disability.35

cInsights based on qualitative data collected from a global, qualitative research study of 54 people affected by MG, a patient council report on six people living with MG, and a literature review of patient-reported outcomes.34

Dr. Areej Bushnaq
Dr. Areej Bushnaq
Consultant Neurologist, Neuromuscular and intraoperative monitoring founder of the women’s neurology chapter - Saudi neurology society
Dr. Abubaker Almadani
Dr. Abubaker Almadani
Vice preseident of EMINS consultant & Head of Neurology department rashid hospital Dubai, UAE
Vision problems in gMG

Vision problems in gMG are common and may impact QoL33,37

These issues can have a negative impact on activities of daily living, such as working or driving33

Patients rate vision problems as one of the top 2 most burdensome gMG symptoms33,37

~85% of patients with gMG experience ocular muscle weakness, which can be progressive37

  • Resultant double vision and ptosis can impact quality of life33,37
  • 54%-79% of patients with gMG (n=22/28, n=245/452, respectively) report double vision33,38a,b
  • aResults from a questionnaire-based, qualitative, cross-sectional, non-interventional survey (N=452) conducted in Japan in patients 15 years of age and older with MG who were receiving regular outpatient treatment.38
  • bResults from qualitative, cross-sectional, non-interventional study having semi-structured, in-depth concept elicitation interviews (N=28) conducted in the US with adult patients diagnosed with gMG.33

gMG exacerbation and myasthenic crisis

gMG exacerbation39
  • Generally defined as significant worsening of gMG symptoms
  • Typically requires inpatient treatment
  • The most severe type of gMG exacerbation is myasthenic crisis
Myasthenic crisis39,40
  • Severe weakness in respiratory muscles, leading to respiratory failure and requiring intubation and mechanical ventilation

Certain factors are associated with worsening of symptoms and with a high risk of exacerbations40-43

Late onset of disease

Late onset of disease

Autoimmune comorbidities

Autoimmune comorbidities

Hot weather

Hot weather

Infection

Infection

Emotional stress

Emotional stress

Certain drugs, including fluoroquinolone, macrolides and amino glycosides

Certain drugs, including fluoroquinolone, macrolides and amino glycosides

gMG crises

  • Are more common on the first 2 years following disease 44,45
  • Can cause acute symptoms that impact daily life44,46,47
  • Can lead to hospitalization, mechanical ventilation, tube feeding, and death37,48

of patients may experience MG-related hospitalizations, most striking within the first 2-3 years of disease onset. 49*

*This retrospective longitudinal cohort study evaluated 1149 adult patients with gMG living in England using data recorded from 1997 to 2016. 49

In a retrospective study of 70 adult patients with gMG.**

of hospital stays were followed by discharge to a skilled nursing or longterm acute-care facility. 50

**Hospitalized and treated between 2010 and 2019 in USA

Burden of gMG impact multiple aspects of individuals' lives33a

chart

Emotional impact

  • Anxiety (82%)
  • Depression/sadness (75%)
  • Frustration (64%)
  • Fear (57%)
  • Embarrassment (54%)
chart

Social impact

  • Dating/partner (57%)
  • Feeling misunderstood (46%)
chart

Physical impact

  • Gross motor impairment (93%)
  • Hobbies and sports (89%)
  • IADLsᵇ (82%)
  • ADLsᶜ (57%)
  • Fine motor impairment (46%)
chart

Other life domains

  • Impact on work/career (100%)
  • Need for increased planning (89%)
  • Sleep disturbances (89%)
  • Needing assistance (64%)
  • aBased on a qualitative, cross-sectional, noninterventional study involving interviews with 28 adult patients with gMG in the United States.
  • bIADLs are activities with aspects of cognitive and social functioning that are necessary for independent functioning in the community such as shopping, cooking, housework, and managing finances.
  • cADLs are basic self-care activities such as bathing, dressing, grooming, eating, and using the bathroom. ADL, activity of daily living; gMG, generalised myasthenia gravis; IADL, instrumental activity of daily living.

gMG, generalized myasthenia gravis; NMJ, neuromuscular junction, Qol, quality of life

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