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News|Articles|March 2, 2026

Early Add-On Therapy Associated With Strong Clinical Response in MG

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Key Takeaways

  • Multicenter retrospective registry analysis (2018–2024; n=153) compared add-on initiation within 24 months (EIT; n=36) versus later (LIT) in AChR+ generalized MG.
  • Early intensification drove rapid MG-ADL improvement by month 1 and sustained benefit through month 6, whereas later intensification produced smaller, delayed MG-ADL reductions.
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Patients with myasthenia gravis had a more consistent clinical response and fewer deteriorations when using add-on therapy early.

Initiating add-on therapy within 2 years of a myasthenia gravis (MG) diagnosis was associated with a stronger and more consistent clinical response, according to a new study published in the Journal of Neurology.1 Efficacy and tolerability could be improved when treatments are escalated at an earlier time point.

MG is most commonly caused by the acetylcholine receptor (AChR) impeding the transmission of the neuromuscular systems in the body, which can cause weakness across the body’s muscular groups. First-line immunosuppressive therapies can help with symptom control, but add-on therapies exist to help further control symptoms in those with AChR antibody–positive generalized MG (gMG),2 the timing of which is still up for debate. This study aimed to assess what association existed between clinical outcomes in patients with gMG and the timing of add-on therapy.

Patients treated between 2018 and 2024 at 8 German university hospitals were included in the retrospective, observational study. The presence of a clinical phenotype and the detection of autoantibodies against AChR were used to diagnose MG. The German Myasthenia Registry was used to collect data on all participants, including treatment regimens, antibody profiles, and demographic variables. Adverse events and comorbid conditions were also recorded.

The interval between diagnosis and initiation of add-on therapy was used as the means of separating the patients into groups, where those who started add-on therapy within 24 months were placed in the Early Intensified Treatment (EIT) group and any participant who started add-on therapy later was part of the Late Intensified Treatment (LIT) group. Participants were assessed at baseline and 1, 3, and 6 months after baseline. The primary end point was meaningful improvement in quantitative MG (QMG) and MG Activities of Daily Living (MG-ADL) scores.

There were 153 patients with gMG who were included in the analysis, of which 36 were in the EIT group. A total of 66.7% and 70.1% of the EIT and LIT groups were women, respectively. The mean (SD) ages were 49.1 (21.4) years and 54.7 (19.2) years, respectively.

MG-ADL scores were reduced in the EIT cohort as early as 1 month after baseline (3.0 [4.1] points). Months 3 (3.4 [3.6]) and 6 (4.2 [3.7]) saw sustained reduction in scores. The LIT group also saw reductions in scores, but they were more gradual in comparison. Participants in this group had a reduction of 1.5 (3.6) points after 3 months and 1.5 (4.7) points after 6 months. Patient Acceptable Symptom State was reached by 23% of the LIT patients compared with 43.8% of the EIT patients. A clinically meaningful improvement to the MG-ADL score was found in 78.2% of the EIT group compared with 60.8% of the LIT group.

The EIT group had a change in QMG score of 6.2 (5.1) points after 6 months compared with 1.6 (7.4) points in the LIT group. Mean quality of life scores were reduced by 6.2 points compared with 2.3 points in the LIT group. The mean daily prednisone dose fell by 40.5% in the EIT cohort and 18.8% in the LIT cohort after 6 months.

There were some limitations to this study. Confounders may not have been fully controlled due to the retrospective nature of the study. All patients were managed at tertiary referral centers. Each patient’s optimal treatment response may not have been recorded due to the responses being recorded at set intervals. Long-term durability of response may not be adequately assessed due to the follow-up period being only 6 months. Finally, the EIT group started on a higher dose of prednisone at baseline, which could have affected the initial improvement in outcome measures specific to MG.

The researchers concluded that starting add-on therapy within 24 months of diagnosis could help to improve outcomes in patients with gMG with more sustained clinical benefit. “Prospective trials are needed to clarify the underlying mechanisms and validate these observations,” the authors wrote.

References

  1. Oeztuerk M, Huntemann N, Gerischer L, et al. Early versus late add-on therapy in generalized myasthenia gravis: a multicenter real-world cohort study. J Neurol. 2026;273:168. doi:10.1007/s00415-026-13722-3
  2. Goyal N. Complement inhibitors in myasthenia gravis. Neurology Live. December 18, 2023. Accessed March 2, 2026. https://www.neurologylive.com/view/complement-inhibitors-in-myasthenia-gravis

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