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Effects of comorbid diseases on clinical outcomes in patients with myasthenia gravis

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Abstract

Background

This cross-sectional study was undertaken to evaluate the existence and distribution of comorbid disorders among myasthenia gravis (MG) patients according to subgroups and to identify the effects of the comorbid diseases of MG patients on clinical outcomes.

Methods

The patients were divided into six subgroups according to serum antibodies, age at onset, and thymoma presence. All patients were treated in line with the International Consensus Guidance for Management of Myasthenia Gravis. To assess the clinical outcome after treatment for MG, we used the MGFA Post-intervention Status. In generalized MG patients, the good prognosis group included patients who were classified as having minimal-manifestation status or better. In ocular MG patients, the remission subgroup included patients who were classified as having complete stable remission or pharmacological remission status.

Results

Our study included 168 MG patients, 85 were female while 83 were male. Comorbid diseases were present in 124 (73.8%) MG cases. After at least 1 year of follow-up, 106 (86.8%) of the generalized MG patients were in the good prognosis group and 16 (13.2%) generalized MG patients were in the poor prognosis group. 27 (58.6%) ocular MG patients were in the remission group and 19 (41.3%) ocular MG patients were in the non-remission group. Hypertension increased the risk of poor prognosis by 3.55-fold among patients with generalized MG and type 2 DM increased the risk of not achieving remission by 9.32-fold among patients with ocular MG.

Conclusion

Hypertension and type 2 DM had negative effects on the clinical outcomes of MG.

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References

  1. Gilhus NE (2016) Myasthenia Gravis. N Engl J Med 375:2570–2581. https://doi.org/10.1056/NEJMra1602678

    Article  CAS  PubMed  Google Scholar 

  2. Evoli A, Spagni G, Monte G, Damato V (2021) Heterogeneity in myasthenia gravis: considerations for disease management. Expert Rev Clin Immunol 17:761–771. https://doi.org/10.1080/1744666X.2021.1936500

    Article  CAS  PubMed  Google Scholar 

  3. Gilhus NE, Verschuuren JJ (2015) Myasthenia gravis: subgroup classification and therapeutic strategies. Lancet Neurol 14:1023–1036. https://doi.org/10.1016/S1474-4422(15)00145-3

    Article  CAS  PubMed  Google Scholar 

  4. Misra UK, Kalita J, Singh VK, Kumar S (2020) A study of comorbidities in myasthenia gravis. Acta Neurol Belg 120:59–64. https://doi.org/10.1007/s13760-019-01102-w

    Article  PubMed  Google Scholar 

  5. Diaz BC, Flores-Gavilán P, García-Ramos G, Lorenzana-Mendoza NA (2015) Myasthenia Gravis and Its Comorbidities. J Neurol Neurophysiol 6:5. https://doi.org/10.4172/2155-9562.1000317

    Article  CAS  Google Scholar 

  6. Nacu A, Andersen JB, Lisnic V, Owe JF, Gilhus NE (2015) Complicating autoimmune diseases in myasthenia gravis: a review. Autoimmunity 48:362–368. https://doi.org/10.3109/08916934.2015.1030614

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Gilhus NE, Nacu A, Andersen JB, Owe JF (2015) Myasthenia gravis and risks for comorbidity. Eur J Neurol 22:17–23. https://doi.org/10.1111/ene.12599

    Article  CAS  PubMed  Google Scholar 

  8. Klimiec-Moskal E, Quirke M, Leite MI (2022) Comorbidities in older patients with myasthenia gravis - Comparison between early- and late-onset disease. Acta Neurol Scand 145(3):371–374. https://doi.org/10.1111/ane.13549

    Article  PubMed  Google Scholar 

  9. Sanders DB, Wolfe GI, Benatar M, Evoli A, Gilhus NE, Illa I et al (2016) International consensus guidance for management of myasthenia gravis: Executive summary. Neurology 87:419–425. https://doi.org/10.1212/WNL.0000000000002790

    Article  PubMed  PubMed Central  Google Scholar 

  10. Narayanaswami P, Sanders DB, Wolfe G, Benatar M, Cea G, Evoli A et al (2021) International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update. Neurology 96:114–122. https://doi.org/10.1212/WNL.0000000000011124

    Article  PubMed  PubMed Central  Google Scholar 

  11. Jaretzki AIII, Barohn RJ, Ernstoff RM, Kaminski HJ, Keesey JC, Penn AS et al (2000) Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Neurology 55:16–23. https://doi.org/10.1212/wnl.55.1.16

    Article  PubMed  Google Scholar 

  12. Andersen JB, Heldal AT, Engeland A, Gilhus NE (2014) Myasthenia gravis epidemiology in a national cohort; combining multiple disease registries. Acta Neurol Scand Suppl 198:26–31. https://doi.org/10.1111/ane.12233

    Article  CAS  Google Scholar 

  13. Lazaridis K, Tzartos SJ (2020) Autoantibody Specificities in Myasthenia Gravis; Implications for Improved Diagnostics and Therapeutics. Front Immunol 11:212. https://doi.org/10.3389/fimmu.2020.00212

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Yeh JH, Chen HJ, Lin CC, Chen YK, Chiu HC, Kao CH (2015) Risk of diabetes mellitus among patients with myasthenia gravis. Acta Neurol Scand 132:132–138. https://doi.org/10.1111/ane.12374

    Article  CAS  PubMed  Google Scholar 

  15. Sudulagunta SR, Sepehrar M, Sodalagunta MB, Nataraju AS, Raja SKB, Sathyanarayana D et al (2016) Refractory myasthenia gravis - clinical profile, comorbidities and response to rituximab. Ger Med Sci 14:Doc12. https://doi.org/10.3205/000239

    Article  PubMed  PubMed Central  Google Scholar 

  16. Mantegazza R, Antozzi C (2018) When myasthenia gravis is deemed refractory: clinical signposts and treatment strategies. Ther Adv Neurol Disord 11(1756285617749134):2018. https://doi.org/10.1177/1756285617749134.eCollection

    Article  Google Scholar 

  17. Sussman J, Farrugia ME, Maddison P, Hill M, Leite MI, Hilton-Jones D (2015) Myasthenia gravis: Association of British Neurologists’ management guidelines. Pract Neurol 15(3):199–206. https://doi.org/10.1136/practneurol-2015-001126

    Article  PubMed  Google Scholar 

  18. Quan W, Xia J, Tong Q, Lin J, Zheng X, Yang X et al (2018) Myasthenia gravis and chronic inflammatory demyelinating polyneuropathy in the same patient - a case report. Int J Neurosci 128:570–572. https://doi.org/10.1080/00207454.2017.1398160

    Article  PubMed  Google Scholar 

  19. Lin Z, Si Q, Xiaoyi Z (2016) Association between epilepsy and systemic autoimmune diseases: A meta-analysis. Seizure 41:160–166. https://doi.org/10.1016/j.seizure.2016.08.003

    Article  PubMed  Google Scholar 

  20. Citterio A, Beghi E, Millul A, Evoli A, Mantegazza R, Antozzi C et al (2009) Risk factors for tumor occurrence in patients with myasthenia gravis. J Neurol 256:1221–1227. https://doi.org/10.1007/s00415-009-5091-9

    Article  PubMed  Google Scholar 

  21. Andersen JB, Gilhus NE, Sanders DB (2016) Factors affecting outcome in myasthenia gravis. Muscle Nerve 54:1041–1049. https://doi.org/10.1002/mus.25205

    Article  CAS  PubMed  Google Scholar 

  22. Laakso SM, Myllynen C, Strbian D, Atula S (2021) Comorbidities worsen the prognosis of generalized myasthenia gravis post-thymectomy. J Neurol Sci 427:117549. https://doi.org/10.1016/j.jns.2021.117549

    Article  PubMed  Google Scholar 

  23. Alshekhlee A, Miles JD, Katirji B, Preston DC, Kaminski HJ (2009) Incidence and mortality rates of myasthenia gravis and myasthenic crisis in US hospitals. Neurology 72:1548–1554. https://doi.org/10.1212/WNL.0b013e3181a41211

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

Thanks to Mehmet Nurullah Orman for statical analysis

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Authors and Affiliations

  1. Department of Neurology, Necip Fazıl City Hospital, 46050, Kahramanmaras, Turkey

    Huseyin Nezih Ozdemir

  2. Department of Neurology, Ege University Medical School, 35100, Izmir, Turkey

    Hatice Karasoy, Ayse Nur Yuceyar & Ozgul Ekmekci

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  1. Huseyin Nezih Ozdemir
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  2. Hatice Karasoy
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  3. Ayse Nur Yuceyar
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  4. Ozgul Ekmekci
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Correspondence to Ozgul Ekmekci.

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Ethical Approval and Informed Consent

The local ethics committee of the Ege University Medical School approved the study. Informed consent was obtained from all subjects.

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Ozdemir, H.N., Karasoy, H., Yuceyar, A.N. et al. Effects of comorbid diseases on clinical outcomes in patients with myasthenia gravis. Neurol Sci 44, 2923–2931 (2023). https://doi.org/10.1007/s10072-023-06750-8

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