[Pubmed] Clinical heterogeneity, treatment patterns, and outcomes of advanced-age-onset myasthenia gravis in China: a re

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J Clin Neurosci. 2025 Aug 26;141:111586. doi: 10.1016/j.jocn.2025.111586. Online ahead of print.

ABSTRACT

OBJECTIVES: The clinical characteristics and outcomes of myasthenia gravis (MG) with onset at age 50 years or older, which commonly referred to as late-onset MG (LOMG), in elderly patients remain incompletely understood. This study aimed to address the clinical heterogeneity within LOMG and to clarify whether very-late-onset MG (≥70 years) constitutes a distinct phenotype requiring tailored management approaches.

METHODS: We analyzed data from 2783 patients enrolled in the MG Registry between April 1, 2009, and December 31, 2020. Patients with LOMG were further stratified into two subgroups: those with MG onset at age 50-69 years (referred to as Early-LOMG), and those with onset at age ≥70 years (referred to as advanced-onset MG, AOMG). Clinical features, diagnostic tests, treatments, and outcomes were compared across subgroups.

RESULTS: Of the 982 patients with LOMG, 191 (19.4 %) were classified as AOMG. Compared to patients with MG onset at age 50-69 years, those with onset at age ≥70 years (AOMG) had a higher proportion of females (57.6 % vs 48.7 %, p = 0.027), and were more frequently positive for AChR-Ab (81.2 % vs 70.4 %, p = 0.001) and Titin-Ab (32.5 % vs 22.5 %, p = 0.004), and were more likely to present with bulbar muscle involvement at onset (25.3 % vs 14.8 %) and during disease progression (53.7 % vs 38.6 %). The positive rate of repetitive nerve stimulation (RNS) testing was also higher in the AOMG group (57.1 % vs 35.8 %, p = 0.018). Thymoma was less frequent (12.1 % vs 29.6 %, p = 0.006), and fewer AOMG patients underwent thymectomy (2.6 % vs 31.0 %, p < 0.001). AOMG patients generally required fewer immunosuppressive therapies and achieved comparable functional outcomes. However, the mortality rate was significantly higher in the AOMG group (p = 0.020), primarily due to MG crisis.

CONCLUSIONS: AOMG exhibits distinct clinical features compared to Early-LOMG, characterized by a higher frequency of bulbar involvement, lower thymoma prevalence, less aggressive treatment, and higher mortality. Tailored management strategies are warranted for elderly patients with MG.

PMID:40865296 | DOI:10.1016/j.jocn.2025.111586


Source: https://pubmed.ncbi.nlm.nih.gov/4086529 ... t9+e462414