Determinants of Quality of Life in Myasthenia Gravis Patients

Szczudlik, Piotr; Sobieszczuk, Ewa; Szyluk, Beata; Lipowska, Marta; Kubiszewska, Justyna; Kostera‐Pruszczyk, Anna

doi:10.3389/fneur.2020.553626

Cited by 32 publications

(37 citation statements)

References 30 publications

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“…As expected, in the studies based on hospital registries 11 or including generalized MG patients only, 10 the proportion of patients treated with CS and IS is higher, reflecting severity of the disease 12 . In our observation, 49.4% up to 74.8% of hospitalized patients have received CS and 18.1% up to 42.9%—other IS; the more hospitalizations per year, the higher CS and IS use was.…”

Section: Discussionsupporting

confidence: 81%

“…Previous nationwide studies reported percentage of patients ever treated with CS or other IS ranging from 42% to 90% for CS and 28.1%–43% for other IS, with the highest rates reported in voluntary, patient‐submitted database 6‐10 . In our previous hospital‐based registry study, 11 the proportion of patients ever treated with CS was 57.2%, and 41.5% had no history of CS use. Within the current study, we have reported yearly percentage of patients treated with CS and other IS—a snapshot in a well‐defined time‐frame—difficult to compare with the studies using a different methodology.…”

Section: Discussionmentioning

confidence: 68%

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Myasthenia gravis—treatment and severity in nationwide cohort

Sobieszczuk¹,

Napiórkowski

Szczudlik³

et al. 2022

Acta Neuro Scandinavica

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Introduction Myasthenia gravis (MG) is a rare autoimmune disorder of neuromuscular junction. MG healthcare burden has not been studied in Poland before. Methods Data were drawn from the National Health Fund database; MG patient was defined as a person who received at least once medical service with ICD‐10 code MG (G70) and at least two reimbursed prescriptions for pyridostigmine bromide or ambenonium chloride in two consecutive years. We have analyzed treatment: immunosuppression, intravenous immunoglobulins (IVIg), plasma exchange (PE), the number and length of hospitalizations (LOS), intensive care unit (ICU) care, and deaths between 2013 and 2018. Results In 2018, there were 9012 MG patients (F:M 1.62:1), and 30.6% had early ‐onset MG (<50 years). 66.3% received symptomatic treatment only, 33.7%—glucocorticoids (CS) and/or other immunosuppressants (IS), 64.6%—CS only, 17.5%—azathioprine plus CS, 11%—azathioprine only, 4.6%—CS plus other IS (methotrexate, mycophenolate mofetil, cyclosporine, or tacrolimus), and 2%—other IS only. In 2018, 42.3% of patients were hospitalized at least once (mean 2.05/year), 13.7% due to MG (1.47/year). In 2018, 1.63% patients received PE, 2.33% IVIg. In 2013–2018, 2.7%–3.2% of MG patients required hospitalization in ICU. ICU mean LOS 2013–2018 was 11.5–15.0 days/per patient/year. 2.1% of all MG patients had myasthenic crisis. Mean age at death was 75.7 years for MG and 73.9 for general population (p = .006). All‐cause mortality was higher for men (4.1%–5.1%) than for women (2.5%–3.1%), p < .01. Conclusions Our findings confirm significant healthcare burden of MG, comprising a tool to plan resources needed for MG patients.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 68%

Myasthenia gravis—treatment and severity in nationwide cohort

Sobieszczuk¹,

Napiórkowski

Szczudlik³

et al. 2022

Acta Neuro Scandinavica

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“…The proportion of overweight patients in the late-onset group was greater than that in the early-onset group. This pattern could be related to older age, which contributes to reductions in physical activity and possibly susceptibility to the adverse effects of glucocorticoids[ 57 ]. Compared to early-onset MG patients, higher anti-AChR antibody titers were reported in late-onset MG patients[ 57 , 58 ], which may partly be due to immune dysregulation, including age-related decreases in immunocompetence and increases in the production of autoantibodies[ 59 , 60 ].…”

Section: Discussionmentioning

confidence: 99%

Studying the relationship between clinical features and mental health among late-onset myasthenia gravis patients

Yu¹,

Li²,

Ran³

et al. 2022

WJP

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BACKGROUND Mental disorders are common comorbidities among individuals with neurological diseases, and the prevalence of depressive and anxiety-related symptoms in newly referred patients at neurology outpatient clinics is high. There have been few studies on the mental health of patients with late-onset myasthenia gravis (MG). AIM To examine the relationship between clinical features and the mental health symptoms within late-onset MG patients. METHODS A total of 105 patients diagnosed with MG were recruited consecutively from a neuromuscular outpatient clinic between December 2020 and February 2021. Patients were classified into two groups: early-onset MG (age at onset < 50 years, n = 63) and late-onset MG (age at onset ≥ 50 years, n = 42). Social demographic data and information about marital status, education level, clinical symptoms, serum antibody levels, and therapies used were collected for all participants. Participants were also evaluated using the Myasthenia Gravis Composite scale, the Myasthenia Gravis Activities of Daily Living scale, the Myasthenia Gravis Quality of Life 15 (MG-QOL-15) questionnaire, the 17-item version of the Hamilton Depression Rating Scale (HAM-D) and the Hamilton Anxiety Rating Scale (HAM-A). The relationship between clinical features and mental health in late-onset MG patients was examined using multivariate logistic regression analyses. RESULTS Late-onset MG patients were more prone to dyspnea, had higher levels of serum anti-acetylcholine receptor antibodies, and higher total scores on the MG-QOL-15, HAM-D, and HAM-A questionnaires, than early-onset MG patients had ( P < 0.05). Among those with late-onset MG, female patients had higher total HAM-D and HAM-A scores than male patients had ( P < 0.05). High scores on the QOL-15 questionnaire were associated with higher incidences of anxiety and depression, and the association was found to be independent after adjusting for confounding risk factors. In the late-onset subgroup, the areas under the receiver operating characteristic curves for the MG-QOL-15 score-based diagnostic accuracy for anxiety and depression state were 0.816 ( P = 0.001) and 0.983 ( P < 0.001), respectively. CONCLUSION Higher MG-QOL-15 scores were a risk factor for anxiety and depression in late-onset MG, and women with late-onset MG were more likely to have anxiety and depression than men were.

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“…Also, in our study, the duration of the disease had no significant correlation with the initial QOL scores, but it was found that patients with shorter duration of the disease have high significant improvement in QOL score after plasmapheresis. This may be due to rapid physical improvement and patients regaining their usual daily activities all give them improvement [28].…”

Section: Discussionmentioning

confidence: 99%

Determinants of quality of life changes with plasmapheresis in patients with myasthenia gravis

Al-Ahmer

Elshony

2021

Egypt J Neurol Psychiatry Neurosurg

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Background Immunomodulation, including IVIG and plasma exchange, is useful for a crisis or severe exacerbation. Plasma exchange may be slightly faster and more effective in a myasthenic crisis than IVIG. The aim of the current study was to determine the changes in the quality of life (QOL) after plasmapheresis and factors influencing these changes. Results This study was conducted on 98 MG patients diagnosed as moderate to severe myasthenia gravis (according to Myasthenia Gravis Foundation of America classification), 81 patients received alternate day 5 sessions plasmapheresis (TPE group) and 17 patients were on medical treatment only (control group). All patients were subjected to full history, through clinical neurological evaluation and scored with quantitative myasthenia gravis (QMG) score for MG severity at start and after 1 m. Both groups completed the QOL questionnaire at baseline and after 1 month. The MG-QOL-15 scores were computed and we analyzed the change in the QOL scores from baseline to after plasmapheresis groups and compared it with the results for the control group. The scores in QOL scales had significantly decreased after plasmapheresis, and the improvement in QOL scores had a good correlation with the decrease in QMGS. The improvement in QOL and QMG was significantly correlated with younger age, female gender, shorter duration of the illness, presence of AchR antibodies, antibody titer, and thymus hyperplasia. Conclusion Plasmapheresis is effective in improving quality of life in myasthenia gravis patients and this improvement influenced by age, gender, duration of illness, presence of AchR antibodies and their titer, and the thymus pathology.

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Determinants of Quality of Life in Myasthenia Gravis Patients

Cited by 32 publications

References 30 publications

Myasthenia gravis—treatment and severity in nationwide cohort

Myasthenia gravis—treatment and severity in nationwide cohort

Studying the relationship between clinical features and mental health among late-onset myasthenia gravis patients

Determinants of quality of life changes with plasmapheresis in patients with myasthenia gravis

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