A new retrospective study published in the Journal of Neurology spanning 50 years suggests that myasthenia gravis (MG) is increasingly becoming a disease of older adults. This shift, researchers say, could change how doctors treat the condition in the future.
The study’s authors analyzed data on more than 1,000 people with acetylcholine receptor (AChR) antibody positive-MG treated between 1970 and 2020 at a major neurology center to understand how demographic changes have influenced prognosis and therapy response over time.
The findings show a striking rise in the age at disease onset. In the 1970s, patients typically developed symptoms in their mid-30s, but today the average age of onset is about 65. Cases diagnosed after age 65 (known as very late-onset MG) now make up 45% of new diagnoses, compared with just 5% in the 1970s.
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Researchers note that the growing number of older patients may reflect both population aging and improved diagnosis. Biological factors, such as chronic inflammation associated with aging, may also contribute.
The authors evaluated treatment outcomes in more than 500 patients diagnosed since 2000. Around half achieved a favorable outcome, defined as minimal disease symptoms while taking low-dose steroids. Early-onset patients had the highest likelihood of complete stable remission, while remission was rare among those with very late-onset disease.
Older individuals were also more likely to experience treatment-related adverse events and to have comorbidities such as hypertension, diabetes or osteoporosis. Nearly half of treated patients developed therapy-related side effects, most of which were mild, though infections and fractures were also reported.
The study also found that women were more likely to have severe disease and less likely to reach remission, pointing to potential sex-related differences in disease course and treatment patterns.
The researchers concluded that the growing proportion of older people with MG will present new challenges for disease management. They suggest that newer targeted therapies with improved safety profiles may become increasingly important as the patient population continues to age.
“Further real-world data are needed to assess the safety profile of targeted therapies and optimize MG management, particularly in elderly patients,” the authors said.
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