Fatigue is a relevant outcome in patients with myasthenia gravis

Tran, Christopher; Bril, Vera; Katzberg, Hans D.; Barnett, Carolina

doi:10.1002/mus.26069

Cited by 36 publications

(50 citation statements)

References 25 publications

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“…However, although males had more depression that was significantly correlated with disease severity, women were more likely to have greater disease severity. Previous studies have shown similar gender differences in MG severity and QoL with women having worse fatigue and QoL than men [31,32]. Our study is in keeping with those findings.…”

Section: Discussionsupporting

confidence: 92%

Chronic stress, depression and personality type in patients with myasthenia gravis

Bogdan

Barnett

Ali

et al. 2019

Euro J of Neurology

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Background and purpose Stress is a known risk factor for the onset and modulation of disease activity in autoimmune disorders. The aim of this cross‐sectional study was to determine any associations between myasthenia gravis (MG) severity and chronic stress, depression and personality type. Methods In all, 179 consecutive adult patients with confirmed MG attending the Neuromuscular Clinic between March 2017 and December 2017 were included. At baseline, patients were assessed clinically and they completed self‐administered scales for disease severity, perceived stress, depression and personality type. Results Higher disease severity [Myasthenia Gravis Impairment Index (MGII)] showed a moderate correlation with depression score (Beck's Depression Inventory, Second Edition, r = 0.52, P < 0.001) and a lower correlation with chronic stress (Trier Inventory for Assessment of Chronic Stress, r = 0.28, P = 0.001). Chronic stress scores were different according to personality types (anova, P = 0.02). The linear regression model with MGII score as the dependent variable showed R2 = 0.34, likelihood ratio chi‐squared 74.55, with P < 0.0001. The only variables that predicted disease severity were depression scores (P < 0.0001) and female sex (P = 0.003). Conclusions A significant association of MG severity with depression and chronic stress was found, as well as with female gender. These findings should raise awareness that the long‐term management of MG should address depression and potential stress and consider behavioural management to prevent stress‐related immune imbalance.

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Section: Discussionsupporting

confidence: 92%

Chronic stress, depression and personality type in patients with myasthenia gravis

Bogdan

Barnett

Ali

et al. 2019

Euro J of Neurology

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“…Although disease severity is often the primary outcome measure in MG clinical trials, fatigue is frequently neglected. As fatigue in MG is multifactorial (in part caused by MG itself, but also affected by muscle deconditioning, steroid use and mental health), further research is needed to understand better how to address this symptom [24]. Interestingly, the current prednisone dose was not associated with either health utility score in contrast with previous studies where the prednisone dose correlated with health-related quality-of-life scores [25].…”

Section: Furthermore Becausementioning

confidence: 68%

EQ‐5D‐5L and SF‐6D health utility index scores in patients with myasthenia gravis

Barnett

Bril

Bayoumi

2018

Euro J of Neurology

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Background and purpose Health utilities are a preference‐based method of valuing health states that are used in healthcare research, such as economic evaluations. There are limited health utility valuation data for patients with myasthenia gravis (MG). The aim of the study was to describe health utilities for patients with MG and different health states, using the EQ‐5D‐5L and SF‐6D utility instruments, and to explore clinical and demographic determinants of utilities in this population. Methods Patients completed the EQ‐5D‐5L and SF‐6D. In addition, patients were assessed with the Myasthenia Gravis Foundation of America classification, Myasthenia Gravis Impairment Index and MG‐QOL15 as disease‐specific measures, and the Neuro‐QoL Fatigue scale. We calculated mean utilities for each Myasthenia Gravis Foundation of America severity class. We built regression models for the EQ‐5D‐5L and SF‐6D to determine the clinical and demographic factors that determine patients’ valuation of their health state. Results Among 254 patients, mean EQ‐5D‐5L health utilities were as follows: Remission, 0.94 ± 0.03; Minimal Manifestations, 0.92 ± 0.04; Class I, 0.89 ± 0.06; Class II, 0.78 ± 0.16; Class III, 0.58 ± 0.24 and Class IV, 0.61 ± 0.22. Mean SF‐6D health utilities were as follows: Remission, 0.83 ± 0.07; Minimal Manifestations, 0.86 ± 0.14; Class I, 0.82 ± 0.14; Class II, 0.67 ± 0.12; Class III, 0.56 ± 0.11 and Class IV, 0.50 ± 0.10. The limb/axial scores were more highly correlated to health utilities than ocular or bulbar scores. Conclusions We present estimates of health utilities for patients with MG that can be used in cost‐utility and decision analyses. Limb/axial symptoms had a higher impact on health utilities than ocular or bulbar symptoms, which might reflect the impact of mobility on health valuation.

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“…To the best of our knowledge, the association between RMT [32]. Fatigue in myasthenia affects quality of life and can be reduced after treatment [33]. Our results suggest that adjunctive RMT to conventional drug treatment not only reduce fatigue but also improve outcomes in patients with MG. Due to the characteristic of easily getting fatigued with repetitive exercise in MG, our study protocol did not prefer daily RMT because we consider it inappropriate for MG pathophysiology.…”

Section: Discussionmentioning

confidence: 66%

Respiratory Muscle Training Improves Functional Outcomes and Reduces Fatigue in Patients with Myasthenia Gravis: A Single-Center Hospital-Based Prospective Study

Hsu

Lin

Tsai

et al. 2020

BioMed Research International

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Background. Myasthenia gravis (MG) is an immune-mediated disorder characterized by muscle fatigue and fluctuating weakness. Impairment in respiratory strength and endurance has been described in patients with generalized MG. We tested the hypothesis that respiratory muscle training (RMT) can improve functional outcomes and reduce fatigue in patients with MG. Methods. Eighteen patients with mild to moderate MG participated in this study. The training group underwent home-based RMT three times a week for 12 weeks. Sixteen patients with MG without RMT were enrolled as a disease control group. Lung function, autonomic testing, Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), and functional outcome measurement by using quantitative myasthenia gravis (QMG) score and myasthenia gravis composite (MGC) scale were measured before and after the 12-week RMT. Results. The 12-week RMT significantly increased forced vital capacity (FVC) from 77.9±12.6% to 83.8±17.7% (p=0.03), forced expiratory volume in one second (FEV1) from 75.2±18.3% to 83.3±19.0% (p=0.002), and 6-minute walking distance from 403.4±72.2 m to 466.1±68.5 m (p=0.003). The QMG score improved from 9.6±4.1 to 8.1±4.3 (p=0.04) and the MGC scale from 4.4±3.5 to 2.7±2.9 (p=0.02). The fatigue score (MFSI-SF) reduced from 17.1±14.7 to 13.5±16.9 (p=0.03). Conclusion. The home-based RMT is an effective pulmonary function training for MG patients. The RMT can not only improve short-term outcomes but also reduce fatigue in patients with mild to moderate generalized MG.

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Fatigue is a relevant outcome in patients with myasthenia gravis

Abstract: Fatigue in myasthenia correlates with disease severity, affects QoL, and can improve after treatment. Muscle Nerve 58: 197-203, 2018.

Cited by 36 publications

References 25 publications

Chronic stress, depression and personality type in patients with myasthenia gravis

Chronic stress, depression and personality type in patients with myasthenia gravis

EQ‐5D‐5L and SF‐6D health utility index scores in patients with myasthenia gravis

Respiratory Muscle Training Improves Functional Outcomes and Reduces Fatigue in Patients with Myasthenia Gravis: A Single-Center Hospital-Based Prospective Study

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