Taiwan Clinical Practice Guidelines for Myasthenia Gravis

Myasthenia gravis (MG) is an autoimmune neuromuscular disorder characterized by muscle weakness and fatigue due to autoantibodies impairing neuromuscular transmission. With a global prevalence of 40-180 per million, Taiwan has seen a rise in MG cases from 4476 in 2013 to 5752 in 2019, with generalized MG (GMG) prevalence increasing significantly, whereas GMG patients incur substantially higher medical costs and resource utilization compared to non-MG patients. To standardize MG management, the Society formed an expert committee of 37 MG specialists and a patient representative, tasked with developing evidence-based guidelines. The committee, organized into 11 thematic subgroups, conducted a systematic review of literature from 2015 to 2024 and employed a Modified Delphi method to achieve consensus on clinical guidance statements. Recommendations cover diagnosis (e.g., antibody testing and electrophysiological tests), treatment (e.g. thymectomy, steroids, and novel biologics), and management of specific MG subtypes, including ocular, early- and late-onset, muscle-specific tyrosine kinase-related, and refractory MG, as well as myasthenic crisis and neonatal MG. The guidelines emphasize early diagnosis, integrated management of comorbidities, and long-term care strategies, including patient support and tailored exercise programs. These consensus statements aim to enhance care quality, improve patient outcomes, and guide future research and pharmaceutical development in Taiwan's medical community.