Female gender and quality of life outcomes in myasthenia gravis: a systematic review and meta-analysis

Background: Myasthenia gravis (MG) is a rare autoimmune neuromuscular disease characterized by fluctuating muscle weakness and a variable clinical course. While sex differences in MG onset and progression are well documented, the extent to which these disparities affect quality of life (QoL)-particularly through fatigue and psychological burden-remains unexplored. Objectives: To systematically evaluate gender differences in QoL among MG patients and assess whether psychological factors and fatigue contribute to these disparities. Design: A systematic review and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Data sources and methods: Searches were performed in PubMed, Embase, and PsycINFO from inception through February 2025. Eligible studies included adult MG patients with QoL outcomes stratified by gender. QoL scores were synthesized using a random-effects model. Psychological and fatigue-related variables were examined qualitatively. Results: Twelve studies (N = 4744; 2889 women, 1855 men) met the criteria for the systematic review, and five studies (N = 3765) were included in the meta-analysis. Women consistently reported lower QoL compared to men. The initial pooled analysis showed a moderate but non-significant effect (Hedges' g = 0.319, p = 0.0812; I-2 = 94.96%). Sensitivity analysis (excluding an outlier study) reduced heterogeneity (I-2 = 0%) and revealed a significant gender effect (Hedges' g = 0.440, p < 0.001), with women experiencing significantly poorer QoL. Psychological comorbidities-particularly depression and anxiety-and higher levels of fatigue were more prevalent among female patients and consistently associated with lower QoL. Conclusion: Women with MG experience significantly reduced QoL, partially attributable to higher fatigue and psychological burden. These findings underscore the need for gender-sensitive approaches in MG management, including routine psychological screening and fatigue interventions. Future research should adopt standardized assessment tools and explore the impact of hormonal life stages on MG outcomes.