Please see the updated article below as there is more insight on how to spawn the boss! All credit goes to Tibiabosses.com and the author of this post, Mogh. This article was posted recently on 20 October 2019.
During my research I've been able to disprove some theories about Mahatheb summoning. In my opinion no player's activity inside or outside the Tomb affects nor increases the chance to summon the boss. I mean theories related to killing specific amount of monsters, standing on specific SQMs etc.
As I have mentioned before, Mahatheb's resp is shared with a vampire and a bonebeast and that's an undeniable fact. Theory which appears to be the most probable is the one stating that ech vampire kill gives you some percent chance that the next spawned monster would be a vampire, bonebeast or Mahatheb. Having in mind that the chance for the Mahatheb to appear is very low.
Why such a conclusion? First of all, this spawn mechanism is assigned to some bosses. Manhunter and Mean Masher are the examples. And it is worth to be mentioned that they have been implemented to the game in the same update as Mahatheb. Secondly, we conducted a month-long research with user Monte and the results appear to be matching this exact theory.
Along with Monte, we killed the vampire resp a dozen of hours a day for over a month. Effect? Mahatheb appeared 6 times of which 4 were my kills, 1 Monte's and 1 for someone unknown. Quite a nice score for one of the most rare bosses. Wasn't it?
What is more, I've managed to kill 2 bosses in one day and the video below is a proof...........
https://www.youtube.com/watch?v=kR_3DMrajQk&feature=emb_logo
According to my estimates, Mahatheb spawns approximately once in a few hundred times. The longest streak without the boss was over 1200 times. The shortest - just a dozen. I am sure that no one hunted in the Tomb during the day I killed 2 Mahathebs.
Our collaborative research with Monte proved one thing for sure - everyone can meet Mahatheb. It is just a matter of will and ability to sacrifice a lot of time. I think that a minimum of 4 hours of killing vampires/bonebeasts a day should be enough.
In my opinion the Mahatheb's mystery is a result of the fact that he is being killed so rarely. Moreover he sometimes spawned more than once a day. He hasn't been met on some servers at all. This is very uncommon for a boss and gives a field for speculation. The mechanism described above exist in the game and matches Mahatheb the most. Additionaly it's an easiest and most rational possible solution of his resps riddle.