{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T17:57:08Z","timestamp":1790963828468,"version":"4.1.0"},"reference-count":36,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"unspecified","delay-in-days":173,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Immunovant, Inc.","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Neurol Open"],"accepted":{"date-parts":[[2025,6,8]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The epidemiology of myasthenia gravis (MG), a rare autoimmune disease, is not completely understood. This retrospective claims analysis assessed the epidemiologic rates of MG in the USA and the characteristics of the incident and prevalent MG populations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients with MG were identified using Inovalon closed claims data; those with \u22652 <jats:italic>International Classification of Diseases, 10th Revision<\/jats:italic> (ICD-10) codes for MG from 2016 to 2019, separated by \u226530 days, were eligible. Patients in the prevalent cohort had continuous insurance coverage from January to December 2019. Patients in the incident cohort had continuous insurance coverage from January 2018 to December 2019 and no MG claims before 2019. Incidence and prevalence rates were adjusted using US census data. Treatment utilisation was assessed in both cohorts and grouped by provider type. Exacerbations were identified using ICD-10 code G70.01; codes occurring \u226430 days following a previous exacerbation code were considered as part of a single event.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The incident cohort included 1442 patients (adjusted incidence: 4.3 per 100000); the prevalent cohort included 14\u2009373 patients (adjusted prevalence: 35.7 per 100 000). In 2019, approximately two-thirds of patients in both cohorts (incident, 67.7%; prevalent, 61.6%) received MG treatments, most commonly acetylcholinesterase inhibitors, followed by oral steroids. Among incident patients with \u22651 year of continuous follow-up (n=1204), 32.1% (n=387) experienced \u22651 exacerbation, with 50% (n=194) having \u22652 exacerbations and 41% (n=159) having an exacerbation as the index MG event.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Estimates of MG incidence and prevalence were comparable to findings from two recent US studies. Acetylcholinesterase inhibitors and corticosteroids remain widely used. Exacerbations occurred in &gt;30% of incident patients with \u22651 year of continuous follow-up, including 13% who had a relapse as their index event. These results highlight the need for earlier detection and use of more effective therapies in the treatment paradigm to achieve sustained disease control.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjno-2025-001076","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T14:05:17Z","timestamp":1750687517000},"page":"e001076","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Epidemiology and patient characteristics of the US myasthenia gravis population: real-world evidence from a large insurance claims database"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4983-4041","authenticated-orcid":false,"given":"Lesley-Ann","family":"Miller-Wilson","sequence":"first","affiliation":[{"name":"Immunovant Inc, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Arackal","sequence":"additional","affiliation":[{"name":"Roivant Sciences Ltd, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuriy","family":"Edwards","sequence":"additional","affiliation":[{"name":"Immunovant Inc, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Schwinn","sequence":"additional","affiliation":[{"name":"Immunovant Inc, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen Elizabeth","family":"Rockstein","sequence":"additional","affiliation":[{"name":"Immunovant Inc, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett","family":"Venker","sequence":"additional","affiliation":[{"name":"Roivant Sciences Ltd, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8438-482X","authenticated-orcid":false,"given":"Richard J","family":"Nowak","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"key":"2025072811522140000_7.1.e001076.1","doi-asserted-by":"crossref","DOI":"10.3390\/jcm10112235","article-title":"Myasthenia Gravis: Epidemiology, Pathophysiology and Clinical Manifestations","volume":"10","author":"Dresser","year":"2021","journal-title":"J Clin Med"},{"key":"2025072811522140000_7.1.e001076.2","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2020.596981","article-title":"Myasthenia Gravis: Autoantibody Specificities and Their Role in MG Management","volume":"11","author":"Lazaridis","year":"2020","journal-title":"Front Neurol"},{"key":"2025072811522140000_7.1.e001076.3","doi-asserted-by":"crossref","DOI":"10.3390\/jcm11061597","article-title":"Current Treatment of Myasthenia Gravis","volume":"11","author":"Alhaidar","year":"2022","journal-title":"J Clin Med"},{"key":"2025072811522140000_7.1.e001076.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2019.04.017"},{"key":"2025072811522140000_7.1.e001076.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2019.09.019"},{"key":"2025072811522140000_7.1.e001076.6","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2020.00604","article-title":"A Practical Approach to Managing Patients With Myasthenia Gravis-Opinions and a Review of the Literature","volume":"11","author":"Farrugia","year":"2020","journal-title":"Front Neurol"},{"key":"2025072811522140000_7.1.e001076.7","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2377-10-46","article-title":"A systematic review of population based epidemiological studies in Myasthenia Gravis","volume":"10","author":"Carr","year":"2010","journal-title":"BMC Neurol"},{"key":"2025072811522140000_7.1.e001076.8","doi-asserted-by":"publisher","DOI":"10.25122\/jml-2020-0145"},{"key":"2025072811522140000_7.1.e001076.9","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1002\/mus.28006","article-title":"Incidence and prevalence of myasthenia gravis in the United States: A claims-based analysis","volume":"69","author":"Rodrigues","year":"2024","journal-title":"Muscle Nerve"},{"key":"2025072811522140000_7.1.e001076.10","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2024.1339167","article-title":"Epidemiology of myasthenia gravis in the United States","volume":"15","author":"Ye","year":"2024","journal-title":"Front Neurol"},{"key":"2025072811522140000_7.1.e001076.11","doi-asserted-by":"crossref","DOI":"10.1177\/1756285617749134","article-title":"When myasthenia gravis is deemed refractory: clinical signposts and treatment 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Age and sex composition in the United States. 2020. Available: https:\/\/www.census.gov\/data\/tables\/2020\/demo\/age-and-sex\/2020-age-sex-composition.html"},{"key":"2025072811522140000_7.1.e001076.15","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-021-10891-1"},{"key":"2025072811522140000_7.1.e001076.16","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1007\/s40273-020-00912-8","article-title":"Economic Costs of Myasthenia Gravis: A Systematic Review","volume":"38","author":"Landfeldt","year":"2020","journal-title":"Pharmacoeconomics"},{"key":"2025072811522140000_7.1.e001076.17","doi-asserted-by":"crossref","first-page":"S494","DOI":"10.1016\/j.jval.2022.04.1085","article-title":"HSD85 real-world usage patterns and costs of IVIG treatment in adults with generalized myasthenia gravis in the United States","volume":"25","author":"Qi","year":"2022","journal-title":"Value Health"},{"key":"2025072811522140000_7.1.e001076.18","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s13760-019-01102-w","article-title":"A study of comorbidities in myasthenia gravis","volume":"120","author":"Misra","year":"2020","journal-title":"Acta Neurol Belg"},{"key":"2025072811522140000_7.1.e001076.19","doi-asserted-by":"crossref","first-page":"2965","DOI":"10.1111\/ene.14996","article-title":"The risk of worsening of myasthenia by cardiovascular medication as reflected by reporting frequency","volume":"28","author":"Trillenberg","year":"2021","journal-title":"Eur J Neurol"},{"key":"2025072811522140000_7.1.e001076.20","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.nmd.2019.12.003","article-title":"Emerging therapies for autoimmune myasthenia gravis: Towards treatment without corticosteroids","volume":"30","author":"Tannemaat","year":"2020","journal-title":"Neuromuscul Disord"},{"key":"2025072811522140000_7.1.e001076.21","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/s41572-019-0079-y","article-title":"Myasthenia gravis","volume":"5","author":"Gilhus","year":"2019","journal-title":"Nat Rev Dis Primers"},{"key":"2025072811522140000_7.1.e001076.22","unstructured":"AstraZeneca . Ultomiris approved in the US for adults with generalised myasthenia gravis. 2022. Available: https:\/\/www.astrazeneca.com\/media-centre\/press-releases\/2022\/ultomiris-approved-in-the-us-for-adults-with-generalised-myasthenia-gravis.html"},{"key":"2025072811522140000_7.1.e001076.23","unstructured":"UCB . UCB announces U.S. FDA approval of ZILBRYSQ[\u00ae] (zilucoplan) for the treatment of adults with generalized myasthenia gravis. 2023. Available: https:\/\/www.ucb.com\/newsroom\/press-releases\/article\/ucb-announces-us-fda-approval-of-zilbrysqr-zilucoplan-for-the-treatment-of-adults-with-generalized-myasthenia-gravis"},{"key":"2025072811522140000_7.1.e001076.24","unstructured":"argenx . argenx announces U.S. Food and Drug Administration (FDA) approval of VYVGARTTM (efgartigimod alfa-fcab) in generalized myasthenia gravis. 2021. 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Available: https:\/\/www.jnj.com\/media-center\/press-releases\/johnson-johnson-receives-fda-approval-for-imaavytm-nipocalimab-aahu-a-new-fcrn-blocker-offering-long-lasting-disease-control-in-the-broadest-population-of-people-living-with-generalized-myasthenia-gravis-gmg"},{"key":"2025072811522140000_7.1.e001076.28","doi-asserted-by":"crossref","DOI":"10.1136\/bmjno-2023-000536","article-title":"Batoclimab as induction and maintenance therapy in patients with myasthenia gravis: rationale and study design of a phase 3 clinical trial","volume":"6","author":"Benatar","year":"2024","journal-title":"BMJ Neurol Open"},{"key":"2025072811522140000_7.1.e001076.29","unstructured":"Regeneron Pharmaceuticals . A study to test how safe pozelimab and cemdisiran combination therapy and cemdisiran alone are and how well they work in adult patients with generalized myasthenia gravis (NIMBLE). ClinicalTrials.gov identifier: NCT05070858 . Available: https:\/\/clinicaltrials.gov\/study\/NCT05070858 [Accessed 06 Jan 2025]."},{"key":"2025072811522140000_7.1.e001076.30","unstructured":"Alexion Pharmaceutical, Inc . Safety and efficacy of ALXN1720 in adults with generalized myasthenia gravis. ClinicalTrials.gov identifier: NCT05556096 . 2024. Available: https:\/\/clinicaltrials.gov\/study\/NCT05556096 [Accessed 06 Jan 2025]."},{"key":"2025072811522140000_7.1.e001076.31","unstructured":"Amgen, Myasthenia Gravis Inebilizumab Trial (MINT) . ClinicalTrials.gov identifier: NCT04524273 . 2024. Available: https:\/\/clinicaltrials.gov\/study\/NCT04524273 [Accessed 06 Jan 2025]."},{"key":"2025072811522140000_7.1.e001076.32","unstructured":"Roche H-L . A study to evaluate efficacy, safety, pharmacokinetics, and pharmacodynamics of satralizumab in patients with generalized myasthenia gravis. NCT04963270 . 2024. 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