[Pubmed] Very late-onset myasthenia gravis: a systematic review and meta-analysis of sex distribution, thymic pathology

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J Neurol. 2026 Jul 16;273(8):466. doi: 10.1007/s00415-026-14014-6.

ABSTRACT

OBJECTIVES: We compared very late-onset myasthenia gravis (vloMG; onset ≥ 65 years) with MG beginning before age 65 years (non-vloMG) and contextualized these findings using the conventional early-onset (< 50 years, EOMG) versus late-onset (≥ 50 years, LOMG) classification.

METHODS: MEDLINE, Embase, CENTRAL and Google Scholar were searched from inception through May 2026. Odds ratios (ORs) and 95% confidence intervals were pooled by age group for sex, AChR and MuSK antibody positivity, double-seronegativity, thymoma and thymic hyperplasia.

RESULTS: Eight studies were included. Compared with non-vloMG, vloMG showed higher AChR-antibody positivity (OR, 3.08; 2.23-4.26) and lower double-seronegativity (OR, 0.34; 0.24-0.48) and thymoma prevalence (OR, 0.25; 0.18-0.35). Pooled estimates suggested lower MuSK-antibody positivity (OR, 0.50; 0.26-0.98) and thymic hyperplasia prevalence (OR, 0.22; 0.03-1.66), although these associations did not meet the multiplicity-adjusted significance threshold. Female prevalence did not differ significantly (OR, 0.77; 0.54-1.09). Compared with EOMG, LOMG showed lower female (OR, 0.32; 0.18-0.56) and thymic hyperplasia prevalence (OR, 0.45; 0.33-0.62). AChR-antibody positivity (OR, 1.68; 1.16-2.45), MuSK-antibody positivity (OR, 0.59; 0.35-0.97), double-seronegativity (OR, 0.64; 0.41-0.99) and thymoma prevalence (OR, 0.48; 0.29-0.80) did not meet the multiplicity-adjusted significance threshold. Exploratory analysis showed higher titin-antibody positivity in LOMG (OR, 10.00; 3.03-33.33).

DISCUSSION: Advancing age at MG onset was associated with progressive enrichment of AChR-positive disease and declining MuSK positivity, seronegativity, and thymic pathology. These findings support subdivision into EOMG, intermediate-onset MG (50-64 years, IOMG) and vloMG.

PMID:42461294 | DOI:10.1007/s00415-026-14014-6


Source: https://pubmed.ncbi.nlm.nih.gov/4246129 ... 1&v=2.20.0