Gender differences in clinical outcomes in myasthenia gravis: A prospective cohort study

Abstract

Introduction/Aims It is uncertain whether clinical outcomes differ between male and female patients with myasthenia gravis (MG) while receiving standard clinical care. Methods In a prospective cohort study of 107 patients with MG receiving standard of care from 2012 to 2019, the Quantitative MG (QMG), the MG Composite (MGC), the MG Activities of Daily Living (MG‐ADL), and the MG Quality of Life 15‐Items (QOL15) were determined. Clinical outcomes were analyzed in relation to gender. Results Mean follow‐up time was 4.8 (±0.4) y, and 70 patients completed all follow‐up assessments. Patients improved on all clinical scores: QMG ‐1.8 (P < .001), MGC ‐1.5 (P < .001), MG‐ADL ‐1.3 (P < .001), and QOL15 ‐3.0 (P < .001). Females improved less than males on the QMG (P = .01), MGC (P < .001), MG‐ADL (P = .006), and QOL15 (P < .001) independent of potential confounders. Males had moderate to strong correlations between changes in all clinical scales (r range 0.52 to 0.73), whereas females had weak correlations between changes in the QMG and MG‐ADL (r = 0.13), the QMG and QOL15 (r = 0.27), the MGC and MG‐ADL (r = 0.21), the MGC and QOL15 (r = 0.00), and the MG‐ADL and QOL15 (r = 0.31). Discussion Females improved less compared to males on objective and patient‐reported outcomes. Moreover, females improved more on objective measures than on patient‐reported outcomes. These gender differences should receive attention in clinical care and in the design of future trials.

The Duke Myasthenia Gravis Clinic Registry: II. Analysis of outcomes

“…19 In that study, other factors, including sex and the presence of thymoma, did not significantly affect outcome. Other studies have reported that females improved less than males 24 and that the prognosis is worse in patients with thymoma. [25][26][27] Comparison of our cohort with these studies is limited by many factors, including differences in the populations studied and selection of treatments used.…”

Predictors to health promoting behaviors among patients with myasthenia gravis: health belief model approach

“…The fact that females experience hormonal change along their lives; with estrogen being potent stimulator of autoimmune diseases, could explain partially the increased number of females in the study sample, in addition, using contraceptive pills, which in turn affect the hormonal level that may be considered as risk factors of Myasthenia Gravis (Desai & Brinton, 2019). Another factual explanation is that Myasthenia Gravis affects mostly females before the age of forty years (Thomsen, Vinge, Harbo & Andersen, 2021) and as noted in the results section table 2 that the participants' age at the onset of the disease was between 20 to 40 years old.…”

The effectiveness and side effects of pyridostigmine in the treatment of myasthenia gravis: a cross-sectional study

“…Surprisingly, male patients were also more likely to stop using pyridostigmine, which may be explained by the fact that female patients more frequently have severe or refractory MG [18,19] and male patients appear to respond better to standard care than female patients [20]. This is supported by our post-hoc analysis showing that male patients were more likely than females to report "it was no longer needed due to the start of other medication" as the main reason for discontinuing pyridostigmine, although this difference did not reach statistical significance (probably due to small numbers).…”