Evidence map›Paper›PMID 41760990›Full record

Observational studyJournal of neurology2026

Early versus late add-on therapy in generalized myasthenia gravis: a multicenter real-world cohort study.

Menekse Oeztuerk, Niklas Huntemann, Lea Gerischer, Meret Herdick, Christopher Nelke, Frauke Stascheit, Sarah Hoffmann, Sophie Lehnerer, Maike Stein, Charlotte Schubert and 17 more

Abstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

27 authors.

Menekse Oeztuerk *Department of Neurology, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany. menekse.oeztuerk@bergmannsheil.de.ORCID http://orcid.org/0009-0009-2636-9731
Niklas Huntemann *Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Lea GerischerDepartment of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
Meret HerdickDepartment of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
Christopher NelkeDepartment of Neurology, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany.
Frauke StascheitDepartment of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
Sarah HoffmannDepartment of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
Sophie LehnererDepartment of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
Maike SteinDepartment of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
Charlotte SchubertDepartment of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Christiane Schneider-GoldDepartment of Neurology, St. Josef Hospital Bochum, Ruhr-University Bochum, Bochum, Germany.
Steffen PfeufferDepartment of Neurology, Justus Liebig University of Giessen, Giessen, Germany.
Heidrun H KrämerDepartment of Neurology, Justus Liebig University of Giessen, Giessen, Germany.
Franz Felix KonenDepartment of Neurology, Hannover Medical School, Hannover, Germany.
Thomas SkripuletzDepartment of Neurology, Hannover Medical School, Hannover, Germany.
Marc PawlitzkiDepartment of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Robert RehmannDepartment of Neurology, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany.
Ercan AratDepartment of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Christina B MenskesDepartment of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Stefanie GlaubitzDepartment of Neurology, University Medical Center Göttingen, Göttingen, Germany.
Jana ZschüntzschDepartment of Neurology, University Medical Center Göttingen, Göttingen, Germany.
Valerie ScherwietesDepartment of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TBNS), University Medicine Essen, Essen, Germany.
Andreas TotzeckDepartment of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TBNS), University Medicine Essen, Essen, Germany.
Tim HagenackerDepartment of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TBNS), University Medicine Essen, Essen, Germany.
Andreas MeiselDepartment of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
Sven G MeuthDepartment of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Tobias RuckDepartment of Neurology, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany.

Funding

Deutsche Forschungsgemeinschaft 417677437/GRK2578Deutsche Forschungsgemeinschaft 549557400/RU 2169/5-1Deutsche Forschungsgemeinschaft NE 2774/2-1Else Kröner-Fresenius-Stiftung 2023_EKEA.38
6 · The paper itself

Abstract

backgroundThis study examined whether the timing of targeted add-on therapy initiation influences clinical outcomes in acetylcholine receptor (AChR) antibody-positive generalized myasthenia gravis (gMG), based on the hypothesis that earlier escalation may improve treatment response by intervening before structural or immunological consolidation occurs.

methodsIn this multicenter, retrospective real-world cohort study, 153 patients with AChR antibody-positive gMG were included from eight German tertiary centers. All received either complement C5 inhibitors (eculizumab, ravulizumab) or the FcRn antagonist efgartigimod as add-on therapy. Patients were grouped by treatment initiation within 24 months of diagnosis (Early Intensified Treatment; EIT) or later (Late Intensified Treatment; LIT). MG-ADL, QMG, and MG-QoL15 scores, as well as daily corticosteroid and pyridostigmine doses, were assessed at baseline and at 1, 3, and 6 months.

resultsThe EIT group (n = 36) showed more pronounced and consistent clinical improvement. Significant differences emerged in maximum MG-ADL (p = 0.013) and QMG (p = 0.002) reductions. Patient-acceptable symptom states (MG-ADL ≤ 2, QMG ≤ 7) were more often reached with EIT (p = 0.038, p = 0.006). QMG worsening occurred only in the LIT group (n = 117) (p = 0.021). Prednisone declined more steeply in EIT patients (p = 0.001).

conclusionInitiating add-on therapy within two years of diagnosis was associated with stronger and more consistent clinical responses, fewer deteriorations, and a steeper reduction of treatment burden. These findings support timely escalation as a strategy to enhance both efficacy and tolerability in gMG care.

Indexed as

Adrenal Cortex HormonesAntibodies, Monoclonal, HumanizedComplement Inactivating AgentsMyasthenia GravisAdultAgedCholinesterase InhibitorsCohort StudiesDrug Therapy, CombinationFemaleHumansMaleMiddle AgedReceptors, CholinergicRetrospective StudiesTime FactorsAdrenal Cortex HormonesAntibodies, Monoclonal, HumanizedCholinesterase InhibitorsComplement Inactivating AgentsReceptors, CholinergicAdd-on therapyComplement inhibitionFcRn inhibitionMyasthenia gravisTreatment escalation

Identifiers

PMID41760990
PMCPMC12948894

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.