Recommendations on the management of Myasthenia Gravis in Belgium: development of an academic manuscript

30 april 2024

Myasthenia gravis (MG) is a rare neuromuscular disorder. No Belgian MG guidelines existed. This left Belgian neurologists without locally tailored guidelines that considered the most current clinical information when encountering a new patient.

  • Customer: UZ Gent
  • Period: September 2023 - April 2024
  • Contacts: Lies Schoonaert
  • Keywords: Manuscript development, rare disease, treatment recommendations

The project context

When the project was initiated, no Belgian MG guidelines existed, and international guidelines do not always directly apply to the local Belgian context due to differences in medication (un)availability, reimbursement criteria, or clinical practice in Belgium versus other countries. This left Belgian neurologists—who may have little experience with the disease—without locally tailored guidelines that considered the most current clinical information when encountering a new patient.

The need for support in the clinical management of myasthenia gravis was recognized by clinical experts from the Belgian neuromuscular reference centers (NMRCs), who inquired the development of an academic manuscript covering “Recommendations for the clinical management of Myasthenia Gravis in Belgium.” These recommendations were to fill the knowledge gap many neurologists face and to provide Belgian neurologists with the necessary, hands-on guidance to enable patient-centered management of MG patients.

Hict’s role

Hict was asked to develop a manuscript entitled “Recommendations for the clinical management of myasthenia gravis in Belgium” for publication in Acta Neurologica Belgica, a journal specifically aimed at informing Belgian neurologists. The project was funded by four pharmaceutical companies based in Belgium: Alexion Pharmaceuticals, argenx BV, Janssen Pharmaceuticals, and UCB. Funding companies were invited for a courtesy review of the manuscript before submission yet were not involved in the manuscript development process.

Manuscript flow

Hict used a phased approach consisting of a preparation, review, and closing phase.

During the preparation phase, a draft manuscript was developed based on careful consideration of international guidelines, their applicability to the Belgian situation, other relevant articles encountered during a pragmatic literature search, and input from the two leading experts. This draft was developed in repetitive consultation with the two leading authors until it was ready for broader consultation.

This draft manuscript was reviewed by experts from the seven NMRCs and jointly discussed during an expert meeting. During this review phase, Hict sought to find consensus as much as possible and, if not, to ensure a borne management recommendation.

Hict then finalized the manuscript, obtained approval from the expert co-authors, and submitted the manuscript to Acta Neurologica Belgica. Hict followed up on the manuscript submission, revision, and resubmission, closely involving the experts in the needed adaptations.

What Hict delivered

Hict's hands-on approach has led to an academic publication in Acta Neurologica Belgica. The manuscript is not solely a translation of other documentsbut presents the reader with:

  • An overview of the general treatment strategy in myasthenia gravis (including add-on treatment and tapering strategies).
  • Specified treatment strategies for adult myasthenia gravis (both generalized and ocular myasthenia gravis), with treatment specifications and considerations based on the causal autoantibody.
  • Recommendations on how to manage impending and manifesting myasthenic crises.
  • Considerations to be made regarding comorbidities, drug-disease and drug-drug interactions, and pregnancy in women with myasthenia gravis.

All recommendations are adapted to the specific Belgian situation based on treatment availability, reimbursement criteria, and common clinical practice, providing a hands-on, readily applicable tool supporting Belgian neurologists in the clinical management of myasthenia gravis. The manuscript also considers future perspectives in the rapidly changing field of myasthenia gravis, facilitating the fast adoption of newer treatments and technologies and enhancing patient care.

Thumbnail Management Myasthenia Gravis

Recommendations for the management of myasthenia gravis in Belgium

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