A Delphi consensus on integrating novel therapies into the management of generalized myasthenia gravis

John Vissing; Fritz Zimprich; Sari Atula; Andrew Chan; Henning Andersen; Raffi Topakian; Martijn R. Tannemaat; Konrad P. Weber; Hakan Cetin; Christoph Neuwirth; Hanna Kuusisto; Wolfgang N. Loescher

doi:10.1177/17562864261429176

A Delphi consensus on integrating novel therapies into the management of generalized myasthenia gravis

John Vissing^*
, Fritz Zimprich
, Sari Atula
, Andrew Chan
, Henning Andersen
, Raffi Topakian
, Martijn R. Tannemaat
, Konrad P. Weber
, Hakan Cetin
, Christoph Neuwirth
, Hanna Kuusisto
, Wolfgang N. Loescher

^*Corresponding author for this work

Research output: Contribution to journal › Article › Scientific › peer-review

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Abstract

Background: The treatment landscape for myasthenia gravis (MG) has evolved with the introduction of novel therapies. An international consensus on patient selection criteria and optimal time to initiate these therapies could improve clinical outcomes and reduce delays for likely beneficiaries. Objective: This Delphi consensus was undertaken by MG specialists from selected European countries to explore gaps in the application of national guidelines and elicit expert opinion in practice. Design: A mixed-method approach was used; qualitative and quantitative study phases were combined to explore key concepts and reach consensus. Methods: The qualitative first phase involved seven healthcare professionals (HCPs) and two patient advocacy group representatives who participated in idea generation. Findings from this phase supported the development of a Delphi survey, which was completed by 16 HCPs in two rounds. This constituted the quantitative second phase of the study. Consensus was defined as ⩾70% agreement or disagreement on a 6-point Likert scale. Results: In total, 65% of statements achieved consensus. Key findings include—HCPs highly regard international guidelines but find critical discrepancies between the “ideal” scenario and current clinical practices. Consensus was achieved on the importance of incorporating patient-related quality of life in decision-making, despite limited current methods. Consensus was obtained on steroid tapering and treatment-switch criteria based on steroid dose and duration. Consensus was also achieved on suitable patient profiles, including those with persistent symptoms, severe side effects, or needing rapid control. Conclusion: This study recognized that guidelines offer valuable direction but do not replace individualized treatment decisions. This study identified the areas of alignment and opportunities to refine patient selection criteria and treatment-switch categories, particularly to integrate novel therapy use in MG management, highlighting a path to a more patient-centric approach.

Original language	English
Number of pages	1
Journal	Therapeutic Advances in Neurological Disorders
Volume	19
DOIs	https://doi.org/10.1177/17562864261429176
Publication status	Published - 2026
Publication type	A1 Journal article-refereed

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by sponsorship from Alexion and AstraZeneca Rare Disease. The authors acknowledge and thank Katrin Moser-Schirr and Luis Zurkirchen of Alexion, AstraZeneca Rare Disease, for their recommendation to conduct this study. The authors also thank Vartika Savarna and Alexandra Starry of Cytel for their support in the execution, coordination, and management of this consensus project, including editorial and administrative assistance through the manuscript submission phase. This assistance was funded by Alexion and AstraZeneca Rare Disease. The authors confirm that they authorized the submission of this manuscript via a third party and that they have reviewed and approved the final content of the manuscript, as well as all statements and declarations, including those related to conflicts of interest and funding.

Keywords

Delphi consensus
Europe
generalized
innovative therapies
myasthenia gravis

Publication forum classification

Publication forum level 1

ASJC Scopus subject areas

Pharmacology
Neurology
Clinical Neurology

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10.1177/17562864261429176Licence: CC BY-NC

A Delphi consensus on integrating novel therapies into the management of generalized myasthenia gravisFinal published version, 1.11 MBLicence: CC BY-NC

https://urn.fi/URN:NBN:fi:tuni-202605195860Licence: CC BY-NC

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Vissing, J., Zimprich, F., Atula, S., Chan, A., Andersen, H., Topakian, R., Tannemaat, M. R., Weber, K. P., Cetin, H., Neuwirth, C., Kuusisto, H., & Loescher, W. N. (2026). A Delphi consensus on integrating novel therapies into the management of generalized myasthenia gravis. Therapeutic Advances in Neurological Disorders, 19. https://doi.org/10.1177/17562864261429176

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abstract = "Background: The treatment landscape for myasthenia gravis (MG) has evolved with the introduction of novel therapies. An international consensus on patient selection criteria and optimal time to initiate these therapies could improve clinical outcomes and reduce delays for likely beneficiaries. Objective: This Delphi consensus was undertaken by MG specialists from selected European countries to explore gaps in the application of national guidelines and elicit expert opinion in practice. Design: A mixed-method approach was used; qualitative and quantitative study phases were combined to explore key concepts and reach consensus. Methods: The qualitative first phase involved seven healthcare professionals (HCPs) and two patient advocacy group representatives who participated in idea generation. Findings from this phase supported the development of a Delphi survey, which was completed by 16 HCPs in two rounds. This constituted the quantitative second phase of the study. Consensus was defined as ⩾70\% agreement or disagreement on a 6-point Likert scale. Results: In total, 65\% of statements achieved consensus. Key findings include—HCPs highly regard international guidelines but find critical discrepancies between the “ideal” scenario and current clinical practices. Consensus was achieved on the importance of incorporating patient-related quality of life in decision-making, despite limited current methods. Consensus was obtained on steroid tapering and treatment-switch criteria based on steroid dose and duration. Consensus was also achieved on suitable patient profiles, including those with persistent symptoms, severe side effects, or needing rapid control. Conclusion: This study recognized that guidelines offer valuable direction but do not replace individualized treatment decisions. This study identified the areas of alignment and opportunities to refine patient selection criteria and treatment-switch categories, particularly to integrate novel therapy use in MG management, highlighting a path to a more patient-centric approach.",

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AU - Zimprich, Fritz

AU - Atula, Sari

AU - Chan, Andrew

AU - Andersen, Henning

AU - Topakian, Raffi

AU - Tannemaat, Martijn R.

AU - Weber, Konrad P.

AU - Cetin, Hakan

AU - Neuwirth, Christoph

AU - Kuusisto, Hanna

AU - Loescher, Wolfgang N.

N1 - Publisher Copyright: © The Author(s), 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

PY - 2026

Y1 - 2026

N2 - Background: The treatment landscape for myasthenia gravis (MG) has evolved with the introduction of novel therapies. An international consensus on patient selection criteria and optimal time to initiate these therapies could improve clinical outcomes and reduce delays for likely beneficiaries. Objective: This Delphi consensus was undertaken by MG specialists from selected European countries to explore gaps in the application of national guidelines and elicit expert opinion in practice. Design: A mixed-method approach was used; qualitative and quantitative study phases were combined to explore key concepts and reach consensus. Methods: The qualitative first phase involved seven healthcare professionals (HCPs) and two patient advocacy group representatives who participated in idea generation. Findings from this phase supported the development of a Delphi survey, which was completed by 16 HCPs in two rounds. This constituted the quantitative second phase of the study. Consensus was defined as ⩾70% agreement or disagreement on a 6-point Likert scale. Results: In total, 65% of statements achieved consensus. Key findings include—HCPs highly regard international guidelines but find critical discrepancies between the “ideal” scenario and current clinical practices. Consensus was achieved on the importance of incorporating patient-related quality of life in decision-making, despite limited current methods. Consensus was obtained on steroid tapering and treatment-switch criteria based on steroid dose and duration. Consensus was also achieved on suitable patient profiles, including those with persistent symptoms, severe side effects, or needing rapid control. Conclusion: This study recognized that guidelines offer valuable direction but do not replace individualized treatment decisions. This study identified the areas of alignment and opportunities to refine patient selection criteria and treatment-switch categories, particularly to integrate novel therapy use in MG management, highlighting a path to a more patient-centric approach.

AB - Background: The treatment landscape for myasthenia gravis (MG) has evolved with the introduction of novel therapies. An international consensus on patient selection criteria and optimal time to initiate these therapies could improve clinical outcomes and reduce delays for likely beneficiaries. Objective: This Delphi consensus was undertaken by MG specialists from selected European countries to explore gaps in the application of national guidelines and elicit expert opinion in practice. Design: A mixed-method approach was used; qualitative and quantitative study phases were combined to explore key concepts and reach consensus. Methods: The qualitative first phase involved seven healthcare professionals (HCPs) and two patient advocacy group representatives who participated in idea generation. Findings from this phase supported the development of a Delphi survey, which was completed by 16 HCPs in two rounds. This constituted the quantitative second phase of the study. Consensus was defined as ⩾70% agreement or disagreement on a 6-point Likert scale. Results: In total, 65% of statements achieved consensus. Key findings include—HCPs highly regard international guidelines but find critical discrepancies between the “ideal” scenario and current clinical practices. Consensus was achieved on the importance of incorporating patient-related quality of life in decision-making, despite limited current methods. Consensus was obtained on steroid tapering and treatment-switch criteria based on steroid dose and duration. Consensus was also achieved on suitable patient profiles, including those with persistent symptoms, severe side effects, or needing rapid control. Conclusion: This study recognized that guidelines offer valuable direction but do not replace individualized treatment decisions. This study identified the areas of alignment and opportunities to refine patient selection criteria and treatment-switch categories, particularly to integrate novel therapy use in MG management, highlighting a path to a more patient-centric approach.

KW - Delphi consensus

KW - Europe

KW - generalized

KW - innovative therapies

KW - myasthenia gravis

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DO - 10.1177/17562864261429176

M3 - Article

AN - SCOPUS:105034882243

SN - 1756-2856

VL - 19

JO - Therapeutic Advances in Neurological Disorders

JF - Therapeutic Advances in Neurological Disorders

ER -

A Delphi consensus on integrating novel therapies into the management of generalized myasthenia gravis

Abstract

Funding

Keywords

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