{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T12:36:48Z","timestamp":1764333408294,"version":"3.41.2"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T00:00:00Z","timestamp":1710115200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Early-onset (EOMG) and late-onset (LOMG) are distinct groups of MG patients. It is unclear if treatment strategies and treatment-related adverse events may differ according to the age of MG onset.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This single-center retrospective study includes all MG patients followed at a tertiary center since 2007. We reviewed the electronic clinical records.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 212 patients were identified, 142 (67.0%) females, with a median disease duration of 10\u2009years. The median age of symptom onset was 42.0 (26.0\u201364.5) years, with 130 (61.3%) EOMG cases and 82 (38.7%) LOMG. EOMG were more frequently female, had longer disease duration and often more generalized MG (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). Comorbidities were significantly more frequent in LOMG (67.1%) compared to EOMG (53.1%) (<jats:italic>p<\/jats:italic>\u2009=\u20090.002). Steroid-related adverse effects motivating the switch to steroid-sparing agents (82.0%) were different between groups, with hypertension, hypercholesterolemia, diabetes mellitus and malignancies being more common in LOMG. At the same time, osteoporosis and dyspepsia were more frequent in EOMG (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). The most common first-line choice was azathioprine (45.8%), and rituximab was used in 4 patients (1.9%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our study shows that treatment modalities are similar between EOMG and LOMG, while steroid-related adverse events appear to be distinct.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2024.1277420","type":"journal-article","created":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T05:06:35Z","timestamp":1710133595000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Treatment strategies and treatment-related adverse events in MG according to the age of onset"],"prefix":"10.3389","volume":"15","author":[{"given":"Jo\u00e3o","family":"Moura","sequence":"first","affiliation":[]},{"given":"Joana","family":"Fernandes","sequence":"additional","affiliation":[]},{"given":"Maria Jo\u00e3o","family":"Lima","sequence":"additional","affiliation":[]},{"given":"Ana Paula","family":"Sousa","sequence":"additional","affiliation":[]},{"given":"Raquel","family":"Sam\u00f5es","sequence":"additional","affiliation":[]},{"given":"Ana","family":"Martins Silva","sequence":"additional","affiliation":[]},{"given":"Ernestina","family":"Santos","sequence":"additional","affiliation":[]}],"member":"1965","published-online":{"date-parts":[[2024,3,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1016\/S1474-4422(15)00145-3","article-title":"Myasthenia gravis: subgroup classification and therapeutic strategies","volume":"14","author":"Gilhus","year":"2015","journal-title":"Lancet Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2122","DOI":"10.1016\/S0140-6736(00)05186-2","article-title":"Myasthenia gravis","volume":"357","author":"Vincent","year":"2001","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1212\/WNL.0000000000011124","article-title":"International consensus guidance for management of myasthenia gravis","volume":"96","author":"Narayanaswami","year":"2021","journal-title":"Neurology"},{"key":"ref4","doi-asserted-by":"publisher","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":"ref5","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1111\/ane.13549","article-title":"Comorbidities in older patients with myasthenia gravis \u2014 Comparison between early-and late-onset disease","volume":"145","author":"Klimiec-Moskal","year":"2022","journal-title":"Acta Neurol Scand"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e1171","DOI":"10.1212\/WNL.0000000000008903","article-title":"Clinical and therapeutic features of myasthenia gravis in adults based on age at onset","volume":"94","author":"Cort\u00e9s-Vicente","year":"2020","journal-title":"Neurology"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"161","DOI":"10.3988\/jcn.2012.8.3.161","article-title":"Incidence of thymoma in myasthenia gravis: a systematic review","volume":"8","author":"Mao","year":"2012","journal-title":"J Clin Neurol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1212\/WNL.0000000000002790","article-title":"International consensus guidance for management of myasthenia gravis","volume":"87","author":"Sanders","year":"2016","journal-title":"Neurology"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1016\/8756-3282(94)90280-1","article-title":"Epidemiology and clinical features of osteoporosis in young individuals","volume":"15","author":"Khosla","year":"1994","journal-title":"Bone"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.tem.2006.03.009","article-title":"Glucocorticoid-induced osteoporosis: an update","volume":"17","author":"Mazziotti","year":"2006","journal-title":"Trends Endocrinol Metab"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1007\/s13760-019-01252-x","article-title":"Late-onset generalized myasthenia gravis: clinical features, treatment, and outcome","volume":"120","author":"Yildiz Celik","year":"2020","journal-title":"Acta Neurol Belg"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"102712","DOI":"10.1016\/j.autrev.2020.102712","article-title":"Update in immunosuppressive therapy of myasthenia gravis","volume":"20","author":"Lascano","year":"2021","journal-title":"Autoimmun Rev"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1186\/2047-783X-14-8-364","article-title":"Mycophenolate mofetil as second line immunosuppressant in myasthenia gravis - 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