A recent study identified four key prognostic factors that may predict the risk of relapse for patients with myasthenia gravis (MG) who stop treatment after achieving remission.
The research, published in The European Journal of Neurology, analyzed 196 patients from the Huashan MG Registry who discontinued MG treatment after reaching minimal symptom expression (MSE), a stage where the disease no longer causes functional limitations. Over an average follow-up period of approximately nine years, the study found that 55.1% of patients (108 individuals) experienced a symptom return.
The study identified several factors likely to influence the probability of successful and lasting treatment withdrawal. Patients who were 50 or older when their symptoms first began faced a 68% higher risk of relapse compared to those whose symptoms started at a younger age. Patients who were previously treated with rituximab saw their risk of the disease returning drop by 57%.
Timing also played a vital role. Those who remained on therapy for at least 14.3 months before their symptoms stabilized had a 46% lower risk of relapse. Furthermore, the study highlighted the importance of a “consolidation” period: Patients who waited at least 6.1 months after reaching MSE before stopping their medication reduced their relapse risk by nearly half.
Common triggers identified for relapses included infections, physical fatigue and psychological stress.
Interestingly, a subset of 20 patients from this group underwent a second treatment discontinuation following a previous relapse. For these individuals, the period without a relapse was significantly shorter during the second attempt. This shorter period was particularly noted in patients who did not receive intensified immunotherapy, such as rituximab, following their first relapse.
Additionally, while antibody and thymectomy status were recorded, neither showed a significant correlation with relapse risk in this cohort.
“These findings offer preliminary evidence to inform treatment discontinuation decisions in MG and suggest that individualized approaches incorporating age, treatment history, and adequate consolidation periods may optimize outcomes,” the authors concluded. However, they noted these preliminary findings require validation in larger, multicenter studies.
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