Female gender and quality of life outcomes in myasthenia gravis: a systematic review and meta-analysis.

BACKGROUND

Myasthenia gravis (MG) is a rare autoimmune neuromuscular disease characterized by fluctuating muscle weakness and a variable clinical course. While sex differences in MG onset and progression are well documented, the extent to which these disparities affect quality of life (QoL)-particularly through fatigue and psychological burden-remains unexplored.

OBJECTIVES

To systematically evaluate gender differences in QoL among MG patients and assess whether psychological factors and fatigue contribute to these disparities.

DESIGN

A systematic review and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.

DATA SOURCES AND METHODS

Searches were performed in PubMed, Embase, and PsycINFO from inception through February 2025. Eligible studies included adult MG patients with QoL outcomes stratified by gender. QoL scores were synthesized using a random-effects model. Psychological and fatigue-related variables were examined qualitatively.

RESULTS

Twelve studies ( = 4744; 2889 women, 1855 men) met the criteria for the systematic review, and five studies ( = 3765) were included in the meta-analysis. Women consistently reported lower QoL compared to men. The initial pooled analysis showed a moderate but non-significant effect (Hedges'  = 0.319,  = 0.0812; ² = 94.96%). Sensitivity analysis (excluding an outlier study) reduced heterogeneity (² = 0%) and revealed a significant gender effect (Hedges'  = 0.440,  < 0.001), with women experiencing significantly poorer QoL. Psychological comorbidities-particularly depression and anxiety-and higher levels of fatigue were more prevalent among female patients and consistently associated with lower QoL.

CONCLUSION

Women with MG experience significantly reduced QoL, partially attributable to higher fatigue and psychological burden. These findings underscore the need for gender-sensitive approaches in MG management, including routine psychological screening and fatigue interventions. Future research should adopt standardized assessment tools and explore the impact of hormonal life stages on MG outcomes.

TRIAL REGISTRATION

PROSPERO CRD420251011446.