Neurologists' decision-making in the management of generalised myasthenia gravis: Therapeutic inertia and treatment choices

Abstract

The evolving landscape of generalised myasthenia gravis (gMG) treatment with new targeted immunotherapy options presents challenges for neurologists and potentially leads to therapeutic inertia (TI), the failure to initiate or intensify treatment when therapeutic goals are not met. This study aimed to assess neurologists' therapeutic decision-making process in gMG and its influencing factors. A cross-sectional, web-based study was conducted, involving 149 neurologists (mean age [standard deviation]: 39.0 [9.4] years; 54.4% male; median MG experience [interquartile range]: 7 [3-15] years). Participants responded to 8 simulated case scenarios, 7 of which assessed TI. Overall, 79.9% of neurologists (n = 119/149) exhibited TI in at least 2 of the 7 scenarios. Multivariate analysis revealed that lower organisational support (odd ratio [OR] = 0.308, 95%CI:0.109-0.870, p = 0.0262) and greater reluctance to adopt new treatments (OR = 0.015, 95%CI:0.001-0.739, p = 0.0347) were significant predictors of TI. Understanding these factors is crucial for optimising gMG treatment decisions, underscoring the importance of updated guidelines and continued professional education.