Fatigue in Myasthenia Gravis: Recent Advances and Emerging Concepts.

Fatigue is a common, often disabling symptom in myasthenia gravis (MG), distinct from muscle fatigability, and strongly associated with reduced quality of life. This narrative review examines current evidence on fatigue in MG, its patient impact, and future research directions. Earlier studies, mostly small and heterogeneous, reported a highly variable prevalence of fatigue. Recent large registry-based studies have now established a more consistent prevalence around 60% and confirmed associations with disease severity, depressive symptoms, and physical inactivity. Fatigue has also been assessed as secondary endpoint in phase 3 trials of targeted immunotherapies, with improvements paralleling broader clinical benefits. In contrast, non-pharmacological approaches remain understudied; however, several studies have recently been initiated in which fatigue is a predefined outcome measure. Emerging biomarker evidence suggests that systemic low-grade inflammation may contribute to fatigue. Together, these insights highlight the need for targeted, multidimensional strategies to better understand and treat fatigue in MG.