Prognosis

Symptomatic improvement and clinical remission are the goals of therapy. Most, but not all, patients enjoy good quality of life and normal lifespan due to advances in diagnosis and immunosuppressive treatment. However, the onset of improvement varies greatly from days to months, and some patients have a significant burden of disease.

A prompt response to corticosteroid monotherapy is typical for older men with ocular MG whereas generalized symptoms are slower to improve and require more aggressive therapy. Chronic maintenance drug therapy is often required.

Patients with older age of onset and comorbidities, including other associated autoimmune diseases, typically have a poorer prognosis, although that may not always be the case.[33][152][153]

Disease exacerbation

Can occur due to infections, nonadherence to pharmacotherapy, addition of medications that can worsen MG, surgery, malignancy, administration of immune checkpoint inhibitors as cancer therapy, pregnancy, or other stressors.[3][60][80] Myasthenic crisis can sometimes be averted with aggressive early intervention during an exacerbation.[81]

Pregnancy

In one study of 35 pregnancies in 21 patients with MG, there were 30 live births. The symptoms of 50% of the women worsened in the second trimester (typically those with more severe MG); the other 50% either improved or remained stable. There was an increase in premature rupture of membranes (25.8%) and the most severe complications were abortion (11.4%) and fetal death (2.9%). A cesarean section was performed for two-thirds of births and spinal anesthesia was used in 73.3%. Neonatal MG was seen in 12.9% of live-born infants, and no predictors were found.[154]

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