Utilization of MG‐ADL in myasthenia gravis clinical research and care

Abstract

The Myasthenia Gravis Activities of Living (MG‐ADL) scale is an 8‐item patient‐reported scale that measures myasthenia gravis (MG) symptoms and functional status. The objective of the current review is to summarize the psychometric properties of the MG‐ADL and published evidence of MG‐ADL use. A targeted literature review for published studies of the MG‐ADL was conducted using a database and gray literature search. A total of 48 publications and 35 clinical trials were included. Studies indicated that the MG‐ADL is a reliable and valid measure that has been used as an outcome in clinical trials and observational studies to measure MG symptoms and response to treatment. While most often used as a secondary endpoint in clinical trials, its use as a primary endpoint has increased in recent years. The most common MG‐ADL endpoint is change in MG‐ADL score from baseline, although there has been an increase in the analysis of a responder threshold using the MG‐ADL. A new concept of minimal symptom expression (MSE) has emerged more recently. Duration of treatment effect is another important construct that is being increasingly evaluated using the MG‐ADL. The use of the MG‐ADL as a primary endpoint in clinical trials and in responder threshold analyses to indicate treatment improvement has increased in recent years. MSE using the MG‐ADL shows promise in helping to determine success of treatment and may be the aspirational goal of MG treatment for the future once validated, particularly given the evolving treatment landscape in MG.

Risk factors associated with adverse pregnancy outcomes and postpartum exacerbation in women with myasthenia gravis

“…Clinical exacerbation should meet both requirements: (a) increased MG‐ADL score≥1; (b) a decrement of over 5 percentage of points in SSQ. Clinical improvement also should satisfy both standards: (a) decreased MG‐ADL score≥1; (b) an increment of over 5 percentage of points in SSQ 15,16 . Thyroid disorders include Hashimoto's thyroiditis, hypothyroidism (non‐Hashimoto's thyroiditis), graves’ disease, and hyperthyroidism (non‐Grave's disease) 17 .…”

“…Clinical improvement also should satisfy both standards: (a) decreased MG-ADL score≥1; (b) an increment of over 5 percentage of points in SSQ. 15,16 Thyroid disorders include Hashimoto's thyroiditis, hypothyroidism (non-Hashimoto's thyroiditis), graves' disease, and hyperthyroidism (non-Grave's disease). 17 Exclusive breastfeeding is defined as breastfeeding for at least 2 months without regular replacement of any meal by supplemental feeding.…”

Association Between Myasthenia Gravis–Activities of Daily Living (MG-ADL) and EQ-5D-5L Utility Values: The Additional Effect of Efgartigimod on Utilities

“…To date, there is limited information available on the association between functional status (as measured with the MG-ADL) and utility values [2,[18][19][20] in patients with gMG. The ADAPT phase 3 study is one of the few clinical trials of patients with gMG that assessed and reported both symptom and functional scores (MG-ADL) and utility measures (EQ-5D-5L) [21].…”

“…Generalized myasthenia gravis (gMG) is a neurological condition affecting patients’ muscle strength which often results in problems with fatigue, vision, swallowing, chewing, limb weakness, and breathing [ 1 , 2 ]. Prevalence estimates indicate that MG affects as many as 700,000 people worldwide and 103,000 people in the European Union (EU) [ 3 , 4 ].…”

“…Several disease-specific and generic instruments have been validated in patients with gMG that can be used to assess patients’ symptom severity, functional status, and HRQoL. Developed in 1999, the Myasthenia Gravis Activities of Daily Living (MG-ADL) scale is a disease-specific patient-reported outcome measure assessing gMG symptoms and functional status [ 2 , 10 ]. A recent literature review of 48 publications and 35 clinical trials indicated that the MG-ADL is a valid and reliable measure, increasingly used in observational studies and as a primary endpoint in clinical trials [ 2 ].…”