Social Determinants of Health Lead to Greater Suboptimal Treatment Response in Myasthenia Gravis

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A retrospective study presented at the 2023 AANEM meeting revealed that social determinants of health are linked to poorer treatment outcomes in myasthenia gravis patients, emphasizing the need for identifying and supporting at-risk individuals.

Judith Thompson, PharmD, MPH, rare disease population health strategy lead at UCB Pharma

Judith Thompson, PharmD, MPH

Using medical and pharmacy claims data, data from a retrospective observational study showed that social determinants of health (SDoH) are associated with poorer treatment among patients with myasthenia gravis (MG). Presented at the 2023 American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) annual meeting, held November 1-4, in Phoenix, Arizona, investigators concluded that providers may need to identify patients from at-risk communities who may require additional support.1

Led by Judith Thompson, PharmD, MPH, rare disease population health strategy lead at UCB Pharma, the study looked at 7 different SDoH risk indices and their association with suboptimal therapy response in a cohort of 8839 patients with MG. Conducted between October 2018 and September 2020, the analysis used data from IQVIA Longitudinal Access and Adjundication Data (LAAD) claims that was linked with Socially Determined SDoH indices measured at the level of 5-digit ZIP code.

Coming into the study, patients eligible patients had no MG diagnosis or treatment at baseline, otherwise 12 months before index diagnosis. After a 24-month follow-up after index, 3091 (35.0%) patients received what was considered suboptimal therapy. This was defined as beginning therapy without acetylcholinesterase inhibitor, at least 10 mg/day of corticosteroids for 6 months, at least 300 mg/day of azathioprine for 24 months, or at least 3000 mg/day of mycophenolate for 12 months.

Clinical Takeaways

  1. Social determinants of health (SDoH) are associated with poorer treatment outcomes for myasthenia gravis (MG) patients, indicating a need for additional support.
  2. Patients receiving suboptimal therapy were more likely to be male and initiate treatment within 30 days of diagnosis.
  3. MG patients experience a high disease burden, with social and economic factors contributing to their challenges.

Comparing those with and without suboptimal treatment, individuals who received worse treatment were more likely to be male (52.9% vs 46.0%; P <.01), to have fewer comorbidities (Charlson Index, 0.41 vs 0.46; P <.01), and to initiate treatment within 30 days of index (64.6% vs 47.7%; P <.001). After adjustment, regions with high-risk (vs low-risk) housing environment index score (OR, 1.17; 95% CI, 1.02-1.35) and high-risk food landscape index score (OR, 1.13; 95% CI, 0.99-1.28) had an elevated risk of suboptimal therapy.

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Despite improvements in symptomatic therapies, individuals with MG continue to experience a high burden of disease, with up to 20% experiencing a myasthenic crisis requiring intensive care and respiratory support of their lifetime. Many patients experience issues with performing daily activities, including keeping a stable job. In 2017, a cross-sectional study found that more than one-fourth (27.2%) of patients (n = 917) had experienced unemployment, 4.1% had been unwillingly transferred, and 35.9% had experienced a decrease in income, 47.1% of whom reported that the decrease was more than 50% of their previous total income.2

More recently, a study published in Frontiers Public Health highlighted the direct and indirect costs as major concerns for patients with MG who were experiencing SDoH barriers. Compiling data from 38 individuals, the majority of whom were enrolled in public insurance and not employed, the most commonly reported major economic concerns were for managing funds for emergency care (66%), loss of income (61%), and nonmedical expenses (58%), highlighting the diversity of economic challenges.3

A broader concern of managing everyday finances and budgets was a major concern for 50% of respondents, with 79% concerned to any extent. Among other economic concerns, several other direct non-medical expenses were expressed as a major concern by a subgroup of respondents, including the cost of accessible transportation, home modifications, professional caregiving, and childcare.

Click here for more coverage of AANEM 2023.

REFERENCES
1. Thompson J, Zhang B, Liberman JN, Darer J. Social determinants of health are associated with suboptimal treatment among individuals with myasthenia gravis. Presented at: 2023 AANEM annual meeting; November 1-4; Phoenix, AZ. POSTER 42
2. Nagane Y, Murai H, Imai T, et al. Social disadvantages associated with myasthenia gravis and its treatment: a multicentre cross-sectional study. BMJ Open. 2017;7:e013278
3. Hughers T, Howard JF, Silvestri NJ, et al. The economic burden of individuals living with generalized myasthenia gravis and facing social determinants of health challenges. Front Public Health. 2023;11:1247931. doi:10.3389/fpubh.2023.1247931
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