{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:28:53Z","timestamp":1792114133216,"version":"4.4.0"},"reference-count":20,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,3,23]],"date-time":"2018-03-23T00:00:00Z","timestamp":1521763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006396","name":"Alexion Pharmaceuticals","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006396","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p><jats:italic>Introduction<\/jats:italic>: This study assessed the clinical burden of refractory myasthenia gravis (MG), relative to nonrefractory MG. <jats:italic>Methods<\/jats:italic>: Rates of myasthenic crises, exacerbations, inpatient hospitalizations, and emergency room (ER) visits over a 1\u2010year period were measured for 403 refractory, 3,811 nonrefractory, and 403 non\u2010MG control patients from two administrative health plan databases. <jats:italic>Results<\/jats:italic>: Compared with nonrefractory patients, a significantly greater percentage of refractory patients had at least one myasthenic crisis (21.3% vs. 6.1%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and at least one exacerbation (71.2% vs. 32.4%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) over a 1\u2010year period. Refractory patients were also significantly more likely to be hospitalized and\/or have an ER visit than nonrefractory patients and non\u2010MG controls (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001 for all). <jats:italic>Discussion<\/jats:italic>: Refractory MG patients have significantly greater clinical burden and are more likely to utilize intensive healthcare resources than nonrefractory patients. Furthermore, refractory patients may be at greater risk of crises throughout the disease course than previous studies have suggested. <jats:italic>Muscle Nerve<\/jats:italic> <jats:bold>58<\/jats:bold>: 99\u2013105, 2018<\/jats:p>","DOI":"10.1002\/mus.26114","type":"journal-article","created":{"date-parts":[[2018,2,27]],"date-time":"2018-02-27T23:02:38Z","timestamp":1519772558000},"page":"99-105","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["Burden of illness in patients with treatment refractory myasthenia gravis"],"prefix":"10.1002","volume":"58","author":[{"given":"Nicole M.","family":"Engel\u2010Nitz","sequence":"first","affiliation":[{"name":"Health Economics and Outcomes Research, Optum, 11000 Optum Circle Eden Prairie Minnesota USA 55344"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audra","family":"Boscoe","sequence":"additional","affiliation":[{"name":"Alexion Pharmaceuticals Lexington Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Wolbeck","sequence":"additional","affiliation":[{"name":"Health Economics and Outcomes Research, Optum, 11000 Optum Circle Eden Prairie Minnesota USA 55344"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Johnson","sequence":"additional","affiliation":[{"name":"Health Economics and Outcomes Research, Optum, 11000 Optum Circle Eden Prairie Minnesota USA 55344"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"Silvestri","sequence":"additional","affiliation":[{"name":"University at Buffalo Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,3,23]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1196\/annals.1254.053"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.20950"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.48.5.1253"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2007.04.045"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1602489"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002790"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/SMJ.0b013e31815d4398"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.21521"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/CND.0000000000000034"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.20030"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1196\/annals.1405.033"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq433"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/1756285608093888"},{"key":"e_1_2_7_15_1","first-page":"254","volume-title":"Handbook of biological statistics","author":"McDonald JH","year":"2014"},{"key":"e_1_2_7_16_1","first-page":"255","article-title":"Clinical characteristics of refractory myasthenia gravis patients","volume":"86","author":"Suh J","year":"2013","journal-title":"Yale J Biol Med"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.22327"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30369-1"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.55.1.16"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.1998.tb11015.x"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.52.7.1487"}],"container-title":["Muscle &amp; 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