Premium
Thymectomy may not be associated with clinical improvement in MuSK myasthenia gravis
Author(s) -
Clifford Katherine M.,
HobsonWebb Lisa D.,
Benatar Michael,
Burns Ted M.,
Barnett Carolina,
Silvestri Nicholas J.,
Howard James F.,
Visser Amy,
Crum Brian A.,
Nowak Richard,
Beekman Rachel,
Kumar Aditya,
Ruzhansky Katherine,
Chen IHweii Amy,
Pulley Michael T.,
Laboy Shan M.,
Fellman Melissa A.,
Howard Diantha B.,
Kolb Noah A.,
Greene Shane M.,
Pasnoor Mamatha,
Dimachkie Mazen M.,
Barohn Richard J.,
Hehir Michael K.
Publication year - 2019
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/mus.26404
Subject(s) - thymectomy , myasthenia gravis , medicine , rituximab , prednisone , odds ratio , clinical endpoint , confidence interval , gastroenterology , clinical trial , surgery , lymphoma
ABSTRACT Introduction : A randomized trial demonstrated benefit from thymectomy in nonthymomatous acetylcholine receptor (AChR)‐antibody positive myasthenia gravis (MG). Uncontrolled observational and histologic studies suggest thymectomy may not be efficacious in anti–muscle‐specific kinase (MuSK)‐MG. Methods : The therapeutic impact of thymectomy was evaluated from data collected for a multicenter, retrospective blinded review of rituximab in MuSK‐MG. Results : Baseline characteristics were similar between thymectomy ( n = 26) and nonthymectomy ( n = 29) groups, including treatment with rituximab (42% vs. 45%). At last visit, 35% of thymectomy subjects reached the primary endpoint, a Myasthenia Gravis Foundation of America (MGFA) post‐intervention status (PIS) score of minimal manifestations (MM) or better, compared with 55% of controls ( P = 0.17). After controlling for age at onset of MG, rituximab, prednisone, and intravenous immunoglobulin/plasma exchange treatment, thymectomy was not associated with greater likelihood of favorable clinical outcome (odds ratio = 0.43, 95% confidence interval 0.12–1.53, P = 0.19). Discussion : Thymectomy was not associated with additional clinical improvement in this multicenter cohort of MuSK‐MG patients. Muscle Nerve 59:404–410, 2019