Association Between Immunotherapy and Generalization in Ocular Myasthenia Gravis as a Function of Antibody Status

Background:Ocular myasthenia gravis (OMG) is an autoimmune disorder characterized by weakness of the extraocular muscles. This study was developed to investigate the relationship between immunotherapy efficacy and OMG generalization as a function of antibody status, and to explore the efficacy of different immunotherapies in preventing OMG generalization.Methods:This retrospective study included 60 patients admitted to our hospital with initial OMG who were followed for more than two years. Time to generalization was calculated from symptom onset. The proportional hazards assumption was tested using time-dependent covariates, employing Cox regression and Kaplan-Meier analyses to analyze associations for this patient cohort.Results:Among the 60 patients (28 converted OMG; 32 pure OMG), the median time to generalization was 52 months (interquartile range (IQR): 16–117). Antibody positivity was an independent risk factor for generalization (hazard ratio (HR) = 3.89, 95% confidence interval [CI]: 1.26–12.01, p = 0.018). In antibody-positive patients, immunotherapy significantly reduced generalization risk (HR = 0.17, 95% CI: 0.04–0.62, p = 0.008). Conclusion:The time from OMG onset to generalization can be prolonged. While antibody positivity was independently associated with generalization risk in this study cohort, immunotherapy was linked to a time-stable reduction in this risk among antibody-positive patients. These findings provide a preliminary basis for antibody-status-based individualized treatment in OMG.