OBJECTIVES: Myasthenia gravis (MG) is an autoimmune neuromuscular disorder characterized by muscle weakness and fatigue that significantly impacts the quality of life for those affected. While considerable progress has been made in understanding the pathophysiology of MG, understanding the relationship between treatment strategies and the prevalence of comorbidities in MG can help to inform treatment decisions. The purpose of this study was to examine the impact of non-steroidal immunosuppressants (NSISTs) and steroids on the development of comorbidities in MG.

METHODS: The study extracted de-identified data from the National Veterans Affairs Health Care Network's database between January 1999 and March 2022 on patients who had 2 or more MG-related diagnostic claims. The index date was the first recorded diagnosis for MG. Using a multivariate time-dependent Cox Model, the study evaluated the impact of NSISTs and steroids on comorbidity development in MG while adjusting for patient demographic and other disease-related characteristics.

RESULTS: A total of 10,632 patients with MG were identified with a mean age at diagnosis of 70.5 years. Patients were followed for a median of 7 years. Among the 14 comorbidities examined in the study, use of steroids was associated with a significantly higher risk of developing osteoporosis (Hazard Ratio, HR:1.35); autoimmune conditions (HR:1.23), glaucoma (HR:1.22), diabetes (HR:1.22), malignancy (HR:1.19), infection (HR:1.18), thyroid disorders (HR:1.17), and depression (HR:1.15) (all p<0.05). Conversely, the results demonstrated that NSISTs were associated with a significantly elevated risk of anxiety (HR:1.26) and sleep-disorders (HR:1.28) (all p<0.05).

CONCLUSIONS: The study found that when treating MG, conventional immunosuppressive therapies including steroids and NSISTs significantly increased the risk of developing several comorbidities, including diabetes, infections, malignancy, glaucoma, and osteoporosis. This result suggests it is important to consider the potential impact of comorbidities in treatment choice selection for patients with MG.