{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T18:00:59Z","timestamp":1785261659630,"version":"3.55.0"},"reference-count":16,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","award":["ESC 300089"],"award-info":[{"award-number":["ESC 300089"]}],"id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n Myasthenia gravis (MG) is a heterogeneous autoimmune disorder of the neuromuscular junction. Diagnosis and management remain challenging in real-world settings, particularly in public health systems. Data from resource-constrained countries are limited. This study aimed to characterize the epidemiological, clinical, and therapeutic profile of MG patients followed in a Brazilian public tertiary center, emphasizing diagnostic delay and treatment outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a retrospective single-center cohort study of 150 adult MG patients evaluated from 2024 to 2025. Clinical, immunological, therapeutic, and diagnostic-journey data were extracted from institutional electronic and paper medical records, and structured patient questionnaires, when available. Patients were classified as drug-responsive, corticosteroid-dependent, or drug-refractory using predefined operational criteria informed by international consensus guidance. Between-group comparisons used parametric or nonparametric tests, and categorical variables were analyzed with chi-square, Fisher\u2019s exact, or Monte Carlo permutation chi-square tests, as appropriate.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The cohort had female predominance (65.3%), with a median age at onset 35.5 years (IQR 25\u201348). Among those tested, most were AChR antibody\u2013positive (67.6%) and presented generalized MG (93.3%). Median diagnostic delay was 11 months, and 47.3% had delays \u22651 year. Refractory MG occurred in 14% and corticosteroid dependence in 10.6%. Documented myasthenic crisis and impending crisis occurred in 25.2% (35\/139) and 27.3% (38\/139), respectively; documented myasthenic crisis was more frequent in refractory than in drug-responsive patients (45.0% vs 21.0%). Treatment-related adverse events were documented in 47.5% (67\/141); among affected patients, the most common were hyperglycemia (37.3%), osteoporosis\/osteopenia (17.9%), and weight gain (16.4%).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n MG patients followed at this Brazilian public tertiary center showed clinical profiles broadly comparable to those reported in international cohorts, but diagnostic delays were frequent. The frequencies of refractory disease and corticosteroid dependence highlight the need for earlier recognition, specialized management, optimized steroid-sparing strategies, and improved access to comprehensive MG care.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0353883","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T17:27:53Z","timestamp":1785259673000},"page":"e0353883","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Myasthenia gravis: Diagnostic journey and therapeutic outcomes in patients followed at a Brazilian public tertiary center \u2014 A retrospective cohort study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4735-2607","authenticated-orcid":true,"given":"Diego Silva","family":"Figueiredo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto Rolim Muro","family":"Martinez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anamarli","family":"Nucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0898-2419","authenticated-orcid":true,"given":"Marcondes Cavalcante","family":"Fran\u00e7a Junior","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"issue":"1","key":"pone.0353883.ref001","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/s41572-019-0079-y","article-title":"Myasthenia gravis","volume":"5","author":"NE Gilhus","year":"2019","journal-title":"Nat Rev Dis Primers"},{"issue":"1","key":"pone.0353883.ref002","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1186\/s12967-021-03185-7","article-title":"Global prevalence of myasthenia gravis and the effectiveness of common drugs in its treatment: a systematic review and meta-analysis","volume":"19","author":"N Salari","year":"2021","journal-title":"J Transl Med"},{"key":"pone.0353883.ref003","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/1471-2377-10-46","article-title":"A systematic review of population based epidemiological studies in Myasthenia Gravis","volume":"10","author":"AS Carr","year":"2010","journal-title":"BMC Neurol"},{"issue":"3","key":"pone.0353883.ref004","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.neurol.2023.09.004","article-title":"Epidemiology of myasthenia gravis in France: a retrospective claims database study (STAMINA)","volume":"180","author":"E Salort-Campana","year":"2024","journal-title":"Rev Neurol (Paris)"},{"issue":"4","key":"pone.0353883.ref005","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.nmd.2023.02.002","article-title":"Epidemiology and treatment of myasthenia gravis: a retrospective study using a large insurance claims dataset in Germany","volume":"33","author":"A Mevius","year":"2023","journal-title":"Neuromuscul Disord"},{"issue":"2","key":"pone.0353883.ref006","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":"E Rodrigues","year":"2024","journal-title":"Muscle Nerve"},{"issue":"9","key":"pone.0353883.ref007","doi-asserted-by":"crossref","first-page":"2254","DOI":"10.1002\/acn3.52122","article-title":"The impact of diagnosis delay on European patients with generalised myasthenia gravis","volume":"11","author":"E Cort\u00e9s-Vicente","year":"2024","journal-title":"Ann Clin Transl Neurol"},{"issue":"2","key":"pone.0353883.ref008","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1002\/acn3.51492","article-title":"Drug-refractory myasthenia gravis: clinical characteristics, treatments, and outcome","volume":"9","author":"E Cort\u00e9s-Vicente","year":"2022","journal-title":"Ann Clin Transl Neurol"},{"issue":"2","key":"pone.0353883.ref009","first-page":"255","article-title":"Clinical characteristics of refractory myasthenia gravis patients","volume":"86","author":"J Suh","year":"2013","journal-title":"Yale J Biol Med"},{"key":"pone.0353883.ref010","doi-asserted-by":"crossref","DOI":"10.12659\/MSM.933296","article-title":"Adverse side effects associated with corticosteroid therapy: a study in 39 patients with generalized myasthenia gravis","volume":"27","author":"S Johnson","year":"2021","journal-title":"Med Sci Monit"},{"issue":"6","key":"pone.0353883.ref011","article-title":"Gender differences in prednisone adverse effects: survey result from the MG registry","volume":"5","author":"I Lee","year":"2018","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"issue":"3","key":"pone.0353883.ref012","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1212\/WNL.0000000000011124","article-title":"International consensus guidance for management of myasthenia gravis: 2020 update","volume":"96","author":"P Narayanaswami","year":"2021","journal-title":"Neurology"},{"issue":"1","key":"pone.0353883.ref013","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s00415-024-12807-1","article-title":"Factors affecting the diagnostic delay of myasthenia gravis","volume":"272","author":"IR Marlet","year":"2024","journal-title":"J Neurol"},{"issue":"1","key":"pone.0353883.ref014","doi-asserted-by":"crossref","DOI":"10.1212\/CPJ.0000000000200244","article-title":"Exploring factors that prolong the diagnosis of myasthenia gravis","volume":"14","author":"M Nguyen","year":"2024","journal-title":"Neurol Clin Pract"},{"key":"pone.0353883.ref015","unstructured":"Ministry of Health (Brazil). Protocolo Cl\u00ednico e Diretrizes Terap\u00eauticas \u2013 Miastenia Gravis. Bras\u00edlia: Minist\u00e9rio da Sa\u00fade; 2022 [cited 2026 Jan 2]. Available from: https:\/\/www.gov.br\/conitec\/pt-br\/midias\/protocolos\/copy_of_20220530_PORTAL_PCDT_Miastenia_Gravis.pdf"},{"issue":"1","key":"pone.0353883.ref016","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1111\/nyas.13518","article-title":"Myasthenia gravis with antibodies to MuSK: an update","volume":"1412","author":"A Evoli","year":"2018","journal-title":"Ann N Y Acad Sci"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0353883","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T17:28:00Z","timestamp":1785259680000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0353883"}},"subtitle":[],"editor":[{"given":"Sonu","family":"Bhaskar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":16,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0353883","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]}}}