Tuan H. Vu, MD - Generalized Myasthenia Gravis Across Serological Subtypes: Challenges in Diagnosis and Treatment Personalization

So let me talk to you about...

GMG and the high costs of diagnostic delay.

So this patient has been going on with her symptoms for about 14 months.

Some people would do antibody testing sequentially.

I usually do all three about the same time because doing sequentially will cost you a few weeks at minimum and maybe more.

And we know that delay can lead to several disadvantages.

Anyway, MG is sort of a rare disease.

The incidence is between four to 30 per million per year.

And the mortality rate is now roughly 3%.

So these patients, when diagnosed, do not die off.

And therefore, the prevalence rate is much higher, between 150 to 200 per million.

The most impacted domains remain ability to perform daily activities.

tiredness, breathing difficulty, visual problems, and also bulbar symptoms such as swallowing and speaking.

In addition to the physical aspect, there's also an emotional or psychological aspect.

There's a high rate of anxiety and depression and social isolation.

And there's also an economic cost where roughly half the patients, and this is pretty consistent across the world, where the patients become underemployed or unemployed.

And in a country such as the United States where unemployment, Insurance and health care is dependent on jobs, and that would be a major problem in terms of the treatment options.

I mentioned before about diagnostic delay and the consequences.

The data we have, which is a few years now, show that the average time from seeking care to diagnosis is roughly 15 and 1 half months, and the patient has seen at least four or five health care providers.

That time frame is a little bit off now.

We know that patients tend to be diagnosed much faster due to the fact that awareness of this condition has increased very drastically over the last few years.

It still takes longer for women and minorities to come to the right diagnosis.

And we know, based on predominantly anecdotal and case report studies and small series, that diagnosis earlier in the course and initiation of treatment, at least for oculomycin gravis, lead to better long-term outcome.

Seronegative patients remain a challenge, and it takes us much longer to come to the diagnosis.

And in the meantime, roughly a quarter of them would have received empiric treatment before diagnosis, and that sometimes can lead to other complications.