Qi Cynthia Z, Lin Yilu, Li Yuebing, Vu Tuan, De Ruyck Femke, Gelinas Deborah, Shi Lizheng
argenx US Inc., Boston, MA, United States.
Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States.
J Neurol Sci. 2025 Jan 15;468:123322. doi: 10.1016/j.jns.2024.123322. Epub 2024 Nov 22.
This retrospective cohort study describes the characteristics of patients with myasthenia gravis (MG) who developed exacerbations (MG-E) and compares their healthcare utilization (HRU) to patients who did not experience exacerbations (MG-O).
De-identified data from patients who had ≥2 MG-related diagnostic code submissions were extracted from the National Veterans Affairs Health Care Network electronic health records between 1999 and 2022. Descriptive statistics, Kaplan-Meier analysis, and per-patient per-year (PPPY) HRU were used to compare the two patient groups.
About 34 % (3603/10,718) of patients with MG developed exacerbations over a median follow-up of 6.8 years. Approximately 52 % of the MG-E cohort had 3 or more exacerbations over the study period, averaging 1.34 (SD 2.50) exacerbations per year. The MG-E cohort had a higher incidence of early-onset MG (7.72 % vs. 4.05 %; p < 0.0001) and higher mean Charlson Comorbidity Index scores before a diagnosis of MG (0.86 vs. 0.59; p < 0.0001). Relative to patients of other racial groups with MG-E, Hispanic and African Americans had higher cumulative incidence of exacerbations over time (p < 0.0001). Additionally, MG-E patients were five times more likely to be intubated compared to MG-O patients (p < 0.0001). Increased PPPY HRU was observed in patients with MG-E compared to patients with MG-O (outpatient visit: 25.05 vs. 14.08; inpatient admission: 0.47 vs. 0.14; ED visit: 0.69 vs. 0.26; ICU stay: 0.08 vs. 0.02, respectively; p < 0.001).
Approximately one-third of patients diagnosed with MG experienced exacerbations, with higher incidences seen among Hispanic and African Americans. MG-E was associated with higher HRU and a higher intubation risk.
这项回顾性队列研究描述了发生病情加重（MG-E）的重症肌无力（MG）患者的特征，并将他们的医疗资源利用情况（HRU）与未经历病情加重的患者（MG-O）进行比较。
从1999年至2022年期间国家退伍军人事务医疗保健网络电子健康记录中提取有≥2次MG相关诊断代码提交的患者的去识别化数据。使用描述性统计、Kaplan-Meier分析和每人每年（PPPY）的HRU来比较这两组患者。
在中位随访6.8年期间，约34%（3603/10718）的MG患者病情加重。在研究期间，约52%的MG-E队列患者有3次或更多次病情加重，平均每年1.34次（标准差2.50）病情加重。MG-E队列早发型MG的发生率更高（7.72%对4.05%；p<0.0001），在诊断MG之前的平均Charlson合并症指数得分更高（0.86对0.59；p<0.0001）。相对于其他种族的MG-E患者，西班牙裔和非裔美国人随着时间推移病情加重的累积发生率更高（p<0.0001）。此外，与MG-O患者相比，MG-E患者插管的可能性高出五倍（p<0.0001）。与MG-O患者相比，MG-E患者的PPPY HRU增加（门诊就诊：25.05对14.08；住院入院：0.47对0.14；急诊就诊：0.69对0.26；重症监护病房停留：0.08对0.02；p<0.001）。
约三分之一被诊断为MG的患者经历了病情加重，西班牙裔和非裔美国人的发生率更高。MG-E与更高的HRU和更高的插管风险相关。
