OBJECTIVES: Generalized Myasthenia Gravis (gMG) is a chronic, autoantibody condition causing muscle weakness. There is no cure, however a range of pharmacological treatments are currently prescribed, typically acetylcholinesterase inhibitors (AChEIs), corticosteroids, and non-steroidal immunosuppressants (NS-ISTs).

METHODS: The Adelphi MG Disease Specific Programme^TM collected point-in-time data from physicians and their patients with gMG (defined as those in MGFA classes II-V) across France, Germany, Italy, Spain and the UK between March – September 2020. Physicians reported patient demographics, treatment history and reasons for treatment selection. A list of 46 reasons for choice was provided for each drug selected at each line of treatment, grouped into five categories of symptom control, administration, safety, suitability and general. Lines of treatment were defined as switching, starting or stopping any maintenance/chronic treatment.

RESULTS: 144 physicians reported the current and historic reasons for choice of maintenance/chronic treatment for 529 patients with gMG. Mean age was 54.0 (SD±15.43), 51.0% were female and average time from diagnosis to survey was 4.1 years (SD±5.27).

Control reasons were most frequently selected at first line (99.6%), Administration at second line (69.7%), and safety (80.0%), suitability (83.6%) and general (87.3%) at a third line or later.

Across all lines of treatment, AChEIs were most frequently prescribed (82.0%), followed by corticosteroids (53.3%), NS-ISTs (50.5%), IVIg/ScIg/PIEx (14.7%) and biologics (13.6%). Across treatment categories, control was selected most frequently for AChEIs (97.9%). Administration (68.9%) and safety (73.4%) were selected most frequently for NS-ISTs. Suitability (68.1%) and general (88.9%) were selected most frequently for biologics.

CONCLUSIONS: These results highlight changing priorities as patients progress through different lines of therapy. Symptom control was the driver of initial treatment choice and AChEI utilisation. Administration, safety and suitability were drivers amongst later lines of treatment options. Safety and convenience concerns indicate efficacious and safe long-term treatment is required to achieve sustained gMG control.