Serological testing patterns among individuals newly diagnosed with myasthenia gravis

Serologic antibody testing supports myasthenia gravis (MG) diagnosis and informs appropriate treatment. The research objective was to evaluate real-world MG serostatus testing patterns in the United States. Using insurance claims linked to serological test results, a retrospective, observational cohort study was conducted among adults with newly diagnosed MG between 01-January-2018 and 30-June-2022. Serostatus tests included acetylcholine receptor (anti-AChR), muscle-specific kinase (anti-MuSK), and low-density lipoprotein receptor-related protein 4 (anti-LRP4) antibodies. Of 5788 cases, 2590 (44.7 %) had at least one valid serology test result: 1453 (56.3 %) seronegative, 1094 (42.4 %) anti-AChR+, 28 (1.1 %) anti-MuSK+, and 5 (0.2 %) anti-LRP4+. Among the seronegative, 56.6 % were only tested for anti-AChR antibodies, 33.7 % tested both anti-AChR and anti-MuSK antibodies, and 5.0 % tested all three antibodies. Of the seronegative and untested populations, 40.9 % and 37.4 % initiated ≥2 unique MG treatments, with 699 (69.4 %) and 1267 (64.7 %) initiating acetylcholinesterase inhibitor. Factors associated with a higher likelihood of obtaining serologic testing included diagnosis by neurology, presence of MG-associated symptoms, residence in large metropolitan areas, fewer comorbidities, and Medicare insurance (vs. commercial or Medicaid). Variation in MG serologic testing, including infrequent MuSK and LRP4 autoantibody testing among seronegative patients, highlights a potential need to promote best practices in patient care.