Long‑term disease control in generalized myasthenia gravis: a systematic literature review

Generalized myasthenia gravis (gMG) is an autoimmune disease, causing impaired muscle contraction and weakness with a debilitating impact on quality of life. Despite a range of established treatment options, long-term outcomes in people with gMG remain poorly understood. A systematic literature review (SLR) was conducted to identify evidence for long-term (> 1 year) disease control and remission in adults with gMG from observational studies published from 2000 onwards. This analysis focused on a subset of publications reporting data for ≥ 1 gMG disease states defined as remission, minimal manifestations (MMs), or change in status. In total, 67 publications from the SLR reported data for ≥ 1 disease states. There was heterogeneity across included studies in terms of disease characteristics, reported treatments, outcomes definitions, and follow-up approaches, which were reflected in outcome reporting variability. No clear trends based on changed disease state over time were observed, however the proportion of patients achieving key clinical goals was generally low. Notably, complete stable remission (CSR), pharmacological remission (PR), and uncategorized remission achievement rates did not exceed 10, 30, and 50%, respectively, at any follow-up timepoint in most studies. Similarly, the proportion of patients achieving MM status, as measured by MM-0, MM-1, and MM-2, remained below 5, 20, and 20%, respectively, across most studies. These results suggest that at least 50% of gMG patients experience persistent symptoms over many years of follow-up. The lack of any trends in improving disease status over time suggests that patients are unable to optimally manage their disease with current treatment options. The protocol for this systematic review has been registered in PROSPERO (CRD420250641579).