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Effect of thymectomy in elderly patients with non-thymomatous generalized myasthenia gravis

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Abstract

Whether thymectomy is beneficial in elderly patients with myasthenia gravis (MG) is unclear. Thus, we assessed whether conducting thymectomy in MG patients aged ≥ 50 years is beneficial. This retrospective cohort study included patients with MG between 1990 and 2018. Thymectomy and control cohorts were selected from among the population of MG patients with an age at onset of ≥ 45 years and elevated concentrations of acetylcholine-receptor antibodies. Patients with evidence of thymic malignancy were excluded. Of these patients, those who underwent thymectomy at the age of ≥ 50 years were designated as the thymectomy group and those who received only medical treatment were designated as the medical treatment group. We compared the Myasthenia Gravis Foundation of America post-intervention status between the thymectomy and medical treatment groups. Landmark analysis was conducted with the landmark set at 24 months. A total of 34 and 105 patients were classified into the thymectomy and medical treatment groups, respectively. Before landmark analysis, the thymectomy group had a higher cumulative incidence of pharmacologic remission (p = 0.009) and complete stable remission (p = 0.022) than the medical treatment group. After landmark analysis, the thymectomy group had a 2.22-fold (95% confidence interval 1.01–4.80) increased chance of achieving pharmacologic remission compared to the medical treatment group after adjustment for age, sex, and disease severity. No significant difference was observed in the rate of relapse after pharmacological remission between the thymectomy (16.7%) and medical treatment groups (21.4%). In conclusion, thymectomy may have a beneficial effect in elderly patients with non-thymomatous generalized MG.

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Acknowledgements

This work was supported by the National Research Foundation of Korea funded by the Korean government (MSIP) (No. 2016R1C1B1010120).

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Authors and Affiliations

  1. Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea

    Seung Woo Kim, Young-Chul Choi, Seung Min Kim & Ha Young Shin

  2. Department of Pathology, Yonsei University College of Medicine, Seoul, South Korea

    Hyo Sup Shim

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  1. Seung Woo Kim
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Correspondence to Ha Young Shin.

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Ethics approval

The study including human participants has been approved by the Severance Hospital Institutional Review Board (Approval No. 4-2018-0869) and has, therefore, been performed in accordance with the Declaration of Helsinki.

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Kim, S.W., Choi, YC., Kim, S.M. et al. Effect of thymectomy in elderly patients with non-thymomatous generalized myasthenia gravis. J Neurol 266, 960–968 (2019). https://doi.org/10.1007/s00415-019-09222-2

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  • DOI: https://doi.org/10.1007/s00415-019-09222-2

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