Myasthenie.com

Eur J Neurol. 2022 Apr 18. doi: 10.1111/ene.15362. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate short- and long-term outcome following thymectomy in patients with acetylcholine-receptor-antibody (AchR-Ab) positive myasthenia gravis (MG).

METHODS: Rates of clinical response (defined as minimal manifestation, pharmacological or complete stable remission) lasting for at least one year were retrospectively analyzed using Cox proportional hazard models. The occurrence of relapses was recorded during follow-up. Clinical factors associated with achieving an initial or a sustained response were analyzed.

RESULTS: 94 patients with a median age of 33 years (IQR 22-51), 68% with non-thymomatous MG and 32% with thymoma-associated MG were included. An initial clinical response was reached in 72% (68/94). Neither sex, age at onset, thymus histology, delay to surgery after disease onset, surgical approach, corticosteroid treatment nor clinical severity before thymectomy were significantly associated with achieving this endpoint. During long-term follow-up (median 89.5 months; IQR 46-189.5) only half of the patients with an initial response (34/68) had a sustained response without relapses. No clinical factors predicted if the response would become sustained. In patients without immunosuppressive treatment before thymectomy (n=24), a high AChR-Ab levels reduction rate after thymectomy was associated with a higher likelihood of achieving an initial response (p=0.03).

CONCLUSION: Sustained long-term clinical response of MG patients after thymectomy is significantly lower than the initial response rates would suggest. The observation that none of the evaluated clinical factors was associated with a worse outcome supports the current clinical practice of patient selection for thymectomy. The relative decline of AchR-antibodies after surgery appears to be a promising prognostic marker.

PMID:35435305 | DOI:10.1111/ene.15362


Source: https://pubmed.ncbi.nlm.nih.gov/3543530 ... 3&v=2.17.6