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. 2023 Jun 23:14:1203679.
doi: 10.3389/fneur.2023.1203679. eCollection 2023.

The growing burden of generalized myasthenia gravis: a population-based retrospective cohort study in Taiwan

Keira Joann Herr  1 , Shih-Pei Shen  2 , Yanfang Liu  3 , Chih-Chao Yang  4 , Chao-Hsiun Tang  2
Affiliations

The growing burden of generalized myasthenia gravis: a population-based retrospective cohort study in Taiwan

Keira Joann Herr et al. Front Neurol. .

Abstract

Background: The prevalence of myasthenia gravis is increasing in many countries, including Asia. As treatment options expand, population-based information about the disease burden can inform health technology assessments.

Methods: We conducted a population-based retrospective cohort study using the Taiwan National Healthcare Insurance Research database and Death Registry to describe the epidemiology, disease burden and treatment patterns of generalized myasthenia gravis (gMG) from 2009 to 2019. Episodes of hepatitis B virus (HBV) infection or reactivation were explored.

Results: The number of patients with gMG increased from 1,576 in 2009 to 2,638 in 2019 and the mean (standard deviation) age from 51.63 (17.32) to 55.38 (16.29) years. The female:male ratio was 1.3:1. Frequently reported co-morbidities were hypertension (32-34% of patients), diabetes mellitus (16-21%) and malignancies (12-17%). The prevalence of patients with gMG increased annually from 6.83/100,000 population in 2009 to 11.18/100,000 population in 2019 (p < 0.0001). There was no temporal trend in all-cause fatality rates (range 2.76-3.79/100 patients annually) or gMG incidence rates (2.4-3.17/100,000 population annually). First-line treatment was with pyridostigmine (82%), steroids (58%), and azathioprine (11%). There was minimal change in treatment patterns over time. Among 147 new HBV infections, 32 (22%) received ≥4 weeks of antiviral therapy suggesting chronic infection. The HBV reactivation rate was 7.2%.

Conclusion: The epidemiology of gMG in Taiwan is evolving rapidly, with higher prevalence rates and increasing involvement of older age-groups suggesting a growing burden of disease and associated healthcare costs. HBV infection or reactivation may pose a previously unrecognized recognized risk for patients with gMG receiving immunosuppressants.

Keywords: Taiwan; database; epidemiology; hepatitis B; incidence; myasthenia gravis; prevalence.

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Conflict of interest statement

KH is an employee of Janssen Asia Pacific. YL is an employee of Epidemiology, Office of the Chief Medical Officer, Johnson and Johnson. KH and YL hold stock in Johnson & Johnson. The authors declare that this study received funding from Janssen Asia Pacific, a division of Johnson and Johnson Pte Ltd. The funder was involved in the study design and provided medical writing support. The funder was not involved in collection, analysis, interpretation of data or the decision to submit it for publication.

Figures

Figure 1
Figure 1
Crude prevalence, all-cause fatality, and incidence rates in patients with generalized myasthenia gravis, Taiwan 2009–2019. gMG, generalized myasthenia gravis. Data are tabulated in Supplementary Tables S2, S4.
Figure 2
Figure 2
Sex-specific and age-specific prevalence of generalized myasthenia gravis in Taiwan, 2009–2019. Data are tabulated in Supplementary Table S2.
Figure 3
Figure 3
Treatments* used by patients for generalized myasthenia gravis in Taiwan, 2009–2019 *Treatments used by <5% of patients were excluded. The total is more than 100% because many patients co-used more than one therapy.
See this image and copyright information in PMC

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