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Updates in the Management of Myasthenia Gravis Insights - Episode 1

Challenges and Burden of Myasthenia Gravis

Ericka Wong, MD, discusses the challenges in the treatment of myasthenia gravis and the burden of myasthenia gravis.

Ericka Wong, MD: My name is Dr Ericka Wong. The name of this program is “Updates in the Management of Myasthenia Gravis.” I’m a clinical assistant professor at Thomas Jefferson University [Philadelphia, Pennsylvania] in the neuromuscular division.

Of the challenges I typically encounter in managing myasthenia gravis, the most obvious 1 is better addressed by some of the newer biologic agents that have come out for the accumulated adverse effects we see with chronic immunosuppression. These are steroids and the other steroid-sparing agents we typically use. Because these medications broadly affect the immune system, they also have significant adverse effects. Balancing the side effects with treating the patient can certainly be challenging.

Another challenge that I’ve come across is the treatment burden to the patient. In particular, patients who have had a significant exacerbation or who are refractory have been admitted to the hospital, and then in the weeks and months afterward, they need very close follow-up. Having to come to the office every month or 2 can be really difficult for patients, along with the extra medications that they’re not used to taking. Compliance can sometimes be difficult just because the burden is so great on that patient. That’s something I’ve also struggled with in the COVID-19 era. One thing that’s been beneficial is the use of telemedicine. I prefer to examine my patients in the office so I can see their symptoms and how strong they are, but if they’re steadily improving, sometimes I’ll incorporate a telemedicine visit or 2 to decrease that burden on the patient.

There’s a great burden of myasthenia gravis on patients, providers, and the health care system. It’s a chronic disease, and patients require long-term or even lifelong therapy. Their clinical symptoms, as well as the treatment, can significantly impact their quality of life. In patients who are refractory or have resistant myasthenia gravis, this is exacerbated because if they have a disease flare-up, they have more frequent health care visits or hospital stays, and this also increases the burden on patients and the health care system. Another aspect is that patients with myasthenia can also have limitations that may decrease their ability to work so they can have decreased job productivity and income. Compounded with the greater health care costs that they also have, it can be a great socioeconomic burden to them and their families.

Transcript Edited for Clarity