Emergent Comorbid Events in First Year of Immunomodulatory Treatment in Adults With Generalized Myasthenia Gravis treated in a Neurology Clinic: A Retrospective Review

Background: Current treatments for myasthenia gravis, including immunomodulatory therapies, are associated with significant comorbid events. Method: Retrospective chart review of all adults diagnosed with generalized myasthenia gravis in our clinic over 5 years to evaluate potential associations between treatment regimens and emergent comorbid events according to system organ class. Comorbid events were categorized by affected system organ class as endocrine, neuropsychiatric, musculoskeletal, gastrointestinal, pulmonary, cardiovascular, urologic, infectious, and hematologic. MG treatment regimens at the latest available date during the 1-year follow-up were categorized by corticosteroid use and further stratified by medication class and combination therapy. Result: A total of 68 patients were included in the analysis (corticosteroid group, n = 43; non-corticosteroid group, n = 25). We found no significant differences in the frequencies of comorbid events between patients whose regimens included corticosteroids and patients with corticosteroid-free regimens. Patients who received pyridostigmine, high-dose corticosteroids, and corticosteroid-sparing agents in combination experienced higher incidences of emergent endocrine and neuropsychiatric events than those who received other corticosteroid-containing treatments. Conclusion: Polypharmacy that included high-dose corticosteroids was associated with a greater incidence of new endocrine and neuropsychiatric comorbid events within 1 year of diagnosis