Use of Glucocorticoids Linked to Health Care Cost, Toxicities in gMG

Glucocorticoids (GCs) imposed a significant economic and clinical burden for patients living with generalized myasthenia gravis (gMG) in a new study published in Medicine.¹ The researchers found that patients who used GCs were more likely to have toxicities and higher health care costs compared with those taking other forms of treatment.

GCs can be used for patients with gMG when symptoms of the condition are not controlled with the use of acetylcholinesterase inhibitors, as GCs act as an immunosuppressant to achieve either remission or minimal manifestation.² GCs need to be taken in the long term to continue to see their effects, despite long-term use being associated with potential toxicities. This study aimed to assess how GCs affect patients with gMG both on a clinical and economic level to assess their effect on patients, specifically focusing on health care resource utilization, health care costs, and incident GC toxicities.

The researchers used the IQVIA PharMetrics Plus data from October 1, 2015, to December 31, 2022, for this study. Individuals in this database are those younger than 65 years in the US who are commercially insured. The study used a retrospective cohort design, and the index date was the most recent calendar date on or after the first diagnosis of gMG. The 12 months before and after the index date were the baseline and study periods, with the 12 months after diagnosis necessitating continuous enrollment in health care. Prescription fills of relevant systemic GCs were used to assess the use of GCs by the patients.

Patients were included if they had 2 or more diagnoses of MG that were 30 or more days apart, had at least 1 diagnosis of MG by a health care provider who was not an ophthalmologist or optometrist, had 24 or more months of continuous health care enrollment, and were 18 years or older at the index date. Participants were split into groups of no GC use and any GC use, with the latter group further split into groups who had taken 5 mg/d or more or 10 mg/d or more. Age, sex, primary health plan type, region of residence, and index year were all collected at the index date.

There were 8833 patients included in the study, of which 42.5% had any use of GC during the study period. A total of 40.9% of the GC-use cohort had used 5 mg or more, and 22.9% used 10 mg or more. The mean age was 52.8 years in the no GC use group and 53.5 years in the any GC use group.

The mean prednisone equivalent daily dose (PEDD) was 6.6 mg in the any-use group during the study period of 12 months. The mean Charlson Comorbidity Index was also higher in the any GC use cohort (1.1 vs 0.7). Increasing levels of GC use corresponded to the use of nonsteroidal immunosuppressants, immunoglobulins, and biologics, and mycophenolate mofetil and azathioprine were the most common prescriptions.

The any-use GC group more commonly had GC toxicities (61.9% vs 52.3% with 1 or more toxicities), and toxicities increased as GC use increased. Three or more incident GC toxicities were more common in patients with any GC use compared with no GC use (16.5% vs 9.5%). Acute and chronic incident GC toxicities were also more common in patients who used any GC use (acute: 28.5% vs 19.1%; chronic: 51.9% vs 43.8%). Nausea and vomiting, pneumonia, and fungal infections were the most common acute toxicities reported. Chronic toxicities included dyslipidemia, sleep disturbances, and obesity.

Health care utilization was higher in the patients with any use of GCs, with a higher rate of visits to the emergency department (43.7% vs 29.6% with 1 or more visits). Health care costs were more than double for patients with any use of GC compared with those with no GC use ($76,381 vs $35,309).

There were some limitations to this study. Differentiating between gMG and ocular MG was based on provider specialty rather than diagnostic codes. Indicators of disease were not adjusted for in this analysis. Medical events that may have been related to toxicity were gathered through diagnosis codes, as claims data did not include adverse events. Temporal relationships between use of GCs and toxicities from GCs were not examined. Data omissions, presence of rule-out diagnoses, and coding errors were all possible due to the retrospective design of the study.

The use of GCs increased the likelihood of toxicities related to treatment and also increased costs for those using GCs to treat their gMG. “There is an unmet need for effective disease-modifying treatments to mitigate GC exposure for improved gMG management and patient outcomes. The introduction of effective alternative treatment options with more favorable safety profiles may help to alleviate the adverse clinical and economic impacts of elevated GC use among patients with gMG,” the authors concluded.

References

1. Silvestri NJ, Park JY, Serra E, et al. Burden of glucocorticoid use in commercially insured adults with generalized myasthenia gravis in the United States: a retrospective claims-based analysis. Medicine (Baltimore). 2026;105(12):e47979. doi:10.1097/MD.0000000000047979
2. Morren JA, Li Y. Myasthenia gravis: frequently asked questions about treatment. Cleveland Clinic. May 30, 2023. Accessed March 24, 2026. https://consultqd.clevelandclinic.org/myasthenia-gravis-frequently-asked-questions-about-treatment