Practitioner’s perception of myasthenia gravis management recommendations in clinical practice: a cross-sectional survey study

Abstract

Background: Myasthenia gravis (MG) is a chronic, fluctuating disease whose unique natural history complicates designing therapeutic trials. The evidence on which many MG management recommendations are based is limited. Objective: To determine the degree of knowledge, agreement, and application of internationally recognized recommendations for managing MG in actual practice. Design: A cross-sectional survey was conducted among Spanish neurologists specializing in MG. Methods: The survey assessed knowledge, agreement, and application of recommendations, along with the degree of agreement with international consensus definitions from the Myasthenia Gravis Foundation of America. Results: Fifty-three neurologists (mean age 45.4 years, 53% men) attended an average of 3.6 patients with MG daily. In 40 out of 61 recommendations, at least 90% of the neurologists were aware of the recommendation. The least known recommendations dealt with juvenile MG and MG in pregnancy. There was no majority agreement in two recommendations (for MG in pregnancy and the use of intravenous immunoglobulin in mild or ocular MG). The implementation of the recommendations was high except for the ones related to plasma exchange, thymectomy, methotrexate, or eculizumab. Conclusion: The recommendations are well-known, agreed upon, and applied. However, the evidence, consensus, and knowledge dissemination need reinforcement regarding aspects such as the management of juvenile MG, MG in pregnancy, or the use of certain treatments.