Corticosteroids Associated With Development of Comorbidities in Myasthenia Gravis

Higher doses of corticosteroids to treat other conditions were found to have an effect on patients diagnosed with myasthenia gravis (MG). According to a study published in Journal of the Neurological Sciences,1 patients with MG who received corticosteroids had an increased risk of developing comorbidities, with those taking higher doses at a particularly increased risk.

MG is an autoimmune disease that can cause skeletal muscle weakness and primarily affects the eyes, face, neck, arms, and legs.2 The condition affects approximately 37.0 per 100,000 population in the US, with a third of these patients younger than 55 years. Generalized MG (gMG) can develop as a part of MG in patients, with those with a gMG diagnosis having poor quality of life and breakthrough exacerbations. Comorbidities are also common in this group of patients with MG. Corticosteroids are a common form of treatment in patients with MG but could have significant adverse effects. This study aimed to evaluate how corticosteroids affected the development of comorbidities in patients with MG in the United States National Veterans Affairs (VA) Health Care Network.

Corticosteroids were associated with the development of comorbidities in patients with MG. | Image credit: Kamitana - stock.adobe.com

The retrospective study used data collected between 1999 and 2024 to evaluate patients. The database included records for more than 8 million veterans across more than 1700 sites of care. Patients with and without gMG had their data extracted to evaluate the impact of corticosteroid use on the development of comorbidities. Diabetes, infections, cardiovascular disease (CVD), depression, osteoporosis, and glaucoma were the main comorbidities that were evaluated for this study.

Patients were included if they were continuously enrolled in the VA health care system and had at least 1 record of a diagnosis of MG. Individuals with only ocular MG records were excluded from the gMG cohort. A random 30% of patients without any record of a diagnosis of MG were included in the non-MG cohort.

There were 10,632 patients included in the analysis who were diagnosed with MG and 10,632 matched controls. Most of the participants were men (95.7%), and the mean age of diagnosis for the MG cohort was 70.5 years. The mean follow-up was 7.8 years in both the MG cohort and the control group.

The mean (SD) treatments of interest were 1.8 (1.2) in the MG cohort compared with 0.2 (0.5) in the control cohort. A total of 84.5% of the patients with MG received 1 or more treatments, and 27.9% received 3 or more treatments. A total of 51.6% of the MG cohort and 21.2% in the control group received corticosteroids during follow-up

In Kaplan-Meier and univariate analyses, the researchers found that the rate of development of all comorbidities was higher in patients in the MG and non-MG groups who received corticosteroids compared with the MG and non-MG groups who did not receive corticosteroids. Annualized HRs were between 1.68 and 4.19 in the MG-corticosteroid patients, 1.54 and 2.65 in the non-MG corticosteroid patients, and between 1.18 and 1.69 in the MG-no corticosteroid patients.

There was a dose-dependent trend toward increased annualized risk after adjusting for demographic and clinical covariates in a multivariate Cox model. These trends affected new-onset diabetes, osteoporosis, CVD, and infections. Medium- to high-dose intensities were found to significantly increase the annualized risk of these comorbidities compared with those who did not take corticosteroids at all. High and medium corticosteroid dose intensities were also linked to significant increases in annualized risk of glaucoma and depression.

There were some limitations to this study, with the most notable being the homogeneity of the VA population included in this study, which could limit generalizability. Any health care services rendered outside of the VA health care network were not recorded. Only corticosteroid dosage in the previous year was included in this analysis, with any dosages in previous years not considered. Data for patients decreased as time went on in the follow-up. The use of other treatments was not taken into account for this analysis, and conclusions cannot be drawn on the impact of any nonsteroids on the development of comorbidities.

Corticosteroids were found to have an effect on the development of comorbidities in those living with MG when taken in higher doses and for longer periods of time. “Our findings support the use of strategies that minimize the use of corticosteroids where possible in clinical practice. Although corticosteroids are inexpensive and readily accessible, their chronic use appears to have significant long-term detrimental impact on health in patients with MG, which may lead to unaccounted care-related costs,” the authors concluded.

References

1. Qi CZ, Lin Y, Li Y, et al. Impact of corticosteroid use on comorbidities in patients with myasthenia gravis in the US National Veterans Affairs Health Network. J Neurol Sci. 2026;481:125716. doi:10.1016/j.jns.2025.125716
2. Myasthenia gravis (MG). Cleveland Clinic. Updated November 10, 2023. Accessed January 20, 2026. https://my.clevelandclinic.org/health/diseases/17252-myasthenia-gravis-mg