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. 2025 Dec;14(6):2345-2357.
doi: 10.1007/s40120-025-00821-y. Epub 2025 Sep 19.

Treatment Preferences of Neurologists in Generalized Myasthenia Gravis: A Conjoint Analysis Study

Luis Querol  1 , Rocío Gómez-Ballesteros  2 , Gerardo Gutiérrez-Gutiérrez  3 , Adrián Ares  4 , Ramón Villaverde  5 , Virginia Reyes  6 , Thaís Armangué  7   8 , Elisa Salas  2 , Paola Díaz-Abós  2 , Pablo Rebollo  9 , Mònica Sarmiento  9 , Neus Canal  9 , Jorge Maurino  10 , Elena Cortés-Vicente  1
Affiliations

Treatment Preferences of Neurologists in Generalized Myasthenia Gravis: A Conjoint Analysis Study

Luis Querol et al. Neurol Ther. 2025 Dec.

Abstract

Introduction: Generalized myasthenia gravis (gMG) is a chronic autoimmune neuromuscular disorder for which treatment decision-making is increasingly complex due to the emergence of biologic targeted therapies. This study aimed to evaluate neurologists' treatment preferences in acetylcholine receptor seropositive gMG using conjoint analysis to simulate real-world clinical decision-making.

Methods: We conducted a cross-sectional, web-based study among neurologists involved in the management of gMG in collaboration with the Spanish Society of Neurology. Participants were presented with eight hypothetical treatment scenarios comprising five key attributes: intensity of improvement, onset of action, duration of effect, adverse events, and route/frequency of administration. Utility values and importance of each attribute were estimated using ordinary least squares regression. Demographic, professional, and behavioral characteristics were assessed to explore variability in preference patterns.

Results: A total of 149 neurologists participated in the study. The mean age was 39.0 (SD 9.4) years, and 54.4% were male. Participants had a mean of 9.9 years (8.4) of experience treating patients with MG. The most valued treatment attribute was intensity of improvement (mean relative importance: 38.6%), followed by onset of action (21.5%) and duration of effect (17.4%). At the individual level, route and frequency of administration accounted for up to 21.9% of decision weight in some participants. Preferences were consistent across neuromuscular specialists and general neurologists but differed based on empathy and conscientiousness. Model fit was robust (Pearson's R = 1.000, p < 0.001).

Conclusions: Neurologists treating gMG placed the highest value on rapid and clinically meaningful symptom improvement, consistent with the therapeutic goals of emerging targeted therapies. However, substantial heterogeneity in preferences, especially regarding administration burden, emphasizes the need for individualized approaches and shared decision-making.

Keywords: Conjoint analysis; Decision-making; Generalized myasthenia gravis; Neurologists; Preferences; Targeted therapies.

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Conflict of interest statement

Declarations. Conflict of Interest: Luis Querol reports receiving speaker honoraria from Merck, Sanofi, Roche, Biogen, Grifols, and CSL Behring; providing expert testimony for Grifols, Johnson & Johnson, Annexon Pharmaceuticals, Sanofi, Novartis, Takeda, and CSL-Behring; and receiving research funds from Roche, UCB, and Grifols. Gerardo Gutiérrez-Gutiérrez reports receiving consulting fees from CSL Behring, Biogen, Alter, Takeda, Akcea, Lupin Neuroscience, Roche, Alexion, and Argenx; congress support from Alter, Esteve, Sanofi-Genzyme, Pfizer, and UCB Pharma; scientific collaborations with Lilly, Alexion, Genzyme, Takeda, Biogen, Pfizer, and Alter; royalties from books published with Exeltis, Alter, Esteve, Andrómaco, and Bristol-Myers; and grants and awards from Lilly, UCB Pharma, and CSL Behring. Adrián Ares reports receiving speaking honoraria, consultation fees, or travel support for congress and scientific meetings attendance from Almirall, Bayer, Biogen, BMS, Janssen, Merck, Novartis, Roche, Sanofi, and Teva. Elena Cortés-Vicente reports consulting or advisory relationships with UCB Pharma SA, Janssen Pharmaceuticals Inc, Alexion Pharmaceuticals Inc, Argenx, and Lundbeck. Mònica Sarmiento, Neus Canal, and Pablo Rebollo are employees of IQVIA Spain, the contract research organization that conducted this study for Roche. Rocío Gómez-Ballesteros, Paola Díaz-Abós, Elisa Salas, and Jorge Maurino are employees of Roche Farma Spain. Ramón Villaverde, Virginia Reyes, and Thaís Armangué declare no conflicts of interest for this work. Ethical Approval: The study was approved by the institutional review board of Hospital Clínico Universitario San Carlos (Madrid, Spain).

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