To evaluate adjunctive cenobamate efficacy by focal seizure subtype during the open-label extension (OLE) of a phase 3 randomized, double-blind, placebo-controlled study (C035) in Asian patients with focal seizures. Patients aged 18–70 years old with uncontrolled focal seizures despite treatment with 1–3 antiseizure medications who completed the double-blind study (n = 425) could enter the 52-week OLE, comprising a 20-week blinded conversion from placebo or 100, 200, or 400 mg/day cenobamate to a target cenobamate dose of 400 mg/day before entering a 32-week open-label maintenance phase at 300 mg/day. Percent change from double-blind baseline in 28-day seizure frequency and responder rates (e.g., ≥ 50
Migraine is a highly prevalent and disabling neurological disorder that imposes a substantial health, social, and economic burden, including significant impacts on workforce participation and productivity. Despite advances in treatment and increased recognition of its burden, migraine remains underdiagnosed, undertreated, and insufficiently prioritized in many health systems. Barriers across the patient journey continue to limit timely diagnosis, effective management, and equitable access to care. This Global Migraine narrative review and expert perspective seek to promote international alignment on the burden of migraine and provide evidence-informed guidance to improve care, workplace support, and policy development worldwide. A two-stage methodology was applied. First, a structured non-systematic literature review synthesized evidence on migraine epidemiology, socioeconomic burden, quality of life, workplace productivity, policies, access to care, and the patient journey. Second, findings were validated and refined through consultations with international experts representing diverse geographies, healthcare systems, and levels of migraine policy development. Two virtual expert panel meetings were held in December 2025 and March 2026, respectively, supported by offline reviews and follow-up consultations. Six key areas of unmet need were identified: diagnosis and disease recognition; knowledge and education; social and psychological impact; access to care; availability and affordability; and treatment quality. Migraine remains largely absent from national health strategies, contributing to fragmented care and inadequate resource allocation. The call-to-action outlines priority recommendations, key stakeholders, and implementation considerations to address these gaps across different health system contexts. Migraine should be recognized as a public health and economic priority. Coordinated strategies are needed to improve diagnosis, care pathways, treatment access, and productivity outcomes, while strengthening global collaboration and policy alignment.
Subcutaneous immunoglobulin (SCIG) therapy is increasingly used to treat chronic inflammatory demyelinating polyneuropathy (CIDP). To support patient-centered care and improve adherence, we evaluated which SCIG treatment attributes matter most to patients and compared experiences using pre-filled syringes (PFS) versus vials. A conjoint analysis was conducted with n = 187 Ig-using patients with CIDP from the USA and Canada to quantify the relative importance of attributes related to self-administered subcutaneous therapy. Following this, a survey of n = 68 SCIG users assessed real-world experiences and preferences with PFS and vial-based administration, including outcomes among patients with CIDP who switched to PFS. The main drivers of preference in subcutaneous therapies were ease of preparation (31
Lecanemab and donanemab are disease-modifying therapies for early Alzheimer’s disease, but their long-term economic value in China remains uncertain. This study evaluated their long-term cost-effectiveness in China. A lifetime Markov model compared lecanemab plus standard of care (SoC), donanemab plus SoC, and SoC alone from the Chinese healthcare system and societal perspectives. Treatment cohorts were stratified by apolipoprotein E ε4 genotype. The model incorporated Chinese real-world costs, treatment-related adverse events, discontinuation, and post-discontinuation benefits. Outcomes included costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). One-way and probabilistic sensitivity analyses assessed parameter uncertainty, while scenario analyses examined drug prices, treatment populations, administration routes, and efficacy assumptions. From the healthcare system perspective, ICERs (in United States dollars [USD]) for lecanemab plus SoC and donanemab plus SoC were USD 309,841.194/QALY and USD 232,793.705/QALY, respectively. Corresponding societal ICERs were USD 300,434.358/QALY and USD 212,256.111/QALY. All estimates exceeded the prespecified willingness-to-pay threshold. The ICER for lecanemab was driven mainly by treatment efficacy and drug price, whereas donanemab was most sensitive to the duration of residual treatment effect. Varying the treatment-eligible population had limited impact on the ICERs. From the healthcare system perspective, ICERs ranged from USD 304,889.902 to USD 310,071.658/QALY for lecanemab and USD 211,226.601 to USD 240,400.661/QALY for donanemab; the corresponding societal ranges were USD 293,467.938–312,810.263/QALY and USD 204,513.613–214,437.087/QALY. At assumed United States prices for subcutaneous lecanemab, intravenous administration had a slightly lower ICER from the healthcare system perspective (USD 309,841.194/QALY versus USD 317,811.454/QALY), whereas all-subcutaneous administration had a slightly lower societal ICER (USD 298,027.332/QALY versus USD 300,434.358/QALY). Neither lecanemab nor donanemab was cost-effective at current Chinese prices. Patient selection had limited impact. The lower ICER for donanemab depended on the assumed residual treatment effect after discontinuation.
Fatigue is a burdensome symptom for many patients with myasthenia gravis (MG) and severely reduces quality of life. Fatigue in MG is described using multiple, partially overlapping concepts, or domains, that are not uniformly defined. The aims of this scoping review were to identify and summarise fatigue concepts related to MG, to review fatigue assessment scales and to evaluate their clinical interpretability, including fatigue caseness, fatigue severity, and clinically meaningful change thresholds. Searches were conducted to identify clinical and observational studies published between 1 January 1990 and 28 February 2025, on PubMed, Embase, ClinicalTrials.gov, EudraCT and Cochrane Library, which presented original research in MG and used a quantitative measurement to assess fatigue. Following identification of fatigue concepts and assessment scales, a targeted secondary search was performed to ascertain clinically meaningful change thresholds for each scale. Seventy-six studies were included. Thirteen fatigue concepts including mental, physical and general fatigue were identified and summarised, with several concepts overlapping. Eighteen fatigue scales used in MG research were identified. Only two scales, Quality of Life in Neurological Disorders Short Form Fatigue and MG Symptoms Patient-Reported Outcome Physical Fatigue, had change thresholds validated in MG. This review highlights heterogeneity in fatigue concepts and assessment approaches used in MG. No single fatigue scale fulfils the key clinical requirements (assessment of caseness, fatigue severity, and presence of a validated clinically meaningful change threshold). Clearer conceptual definitions and further validation of fatigue scales in MG may improve clinical interpretability. Fatigue is a burdensome symptom for people living with myasthenia gravis (MG) that can significantly affect daily activities. Patients can experience different types of fatigue. Patients may also mean different things when they talk about their fatigue, which makes it hard to measure. This is true in MG research too. This review aimed to summarise how fatigue in MG is described, and to identify the assessments used to measure fatigue in people with MG. We also evaluated the usefulness of these assessments for clinicians and patients using three criteria. These criteria were the ability of a scale to (1) identify patients with clinically relevant fatigue; (2) measure different levels of fatigue severity; and (3) detect meaningful changes in fatigue over time. We found 13 types of fatigue (“fatigue concepts”) described in MG research, with a lot of overlap in how they were defined. Our review also found 18 assessments used to measure fatigue in people with MG. Each assessment covered different fatigue concepts. No fatigue scale used in MG fulfilled all three criteria for usefulness. Only two of the assessments (Quality of Life in Neurological Disorders Short Form Fatigue and MG Symptoms Patient-Reported Outcome Physical Fatigue) could determine a “meaningful change” in fatigue for people with MG. Our review highlights the variability in how fatigue is assessed in MG. Clearer definitions of fatigue concepts and further investigation of fatigue assessment scales could help people with MG-related fatigue feel understood, and be assessed and treated appropriately.
