Thymectomy in ocular myasthenia gravis—prognosis and risk factors analysis

Zhang, Jinwei; Zhang, Zeyang; Zhang, Hui; Cui, Yuantao; Chen, Yuan; Lv, Peng; Zhang, Peng

doi:10.1186/s13023-022-02454-y

Cited by 3 publications

(2 citation statements)

References 34 publications

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“…This reduction applied to patients with thymomatous and even more so to nonthymomatous myasthenia gravis. Another recent single center case series of 58 thymectomized patients with ocular myasthenia gravis from China found similar generalization rates of 22.4% after thymectomy, with a higher rate of conversions for thymomatous myasthenia gravis [38].…”

Section: Ocular Myasthenia Gravis and Thymectomymentioning

confidence: 80%

Thymectomy in myasthenia gravis

Rath,

Moser,

Zimprich

2023

Current Opinion in Neurology

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Purpose of review Thymectomy has long been used in the treatment of patients with myasthenia gravis and antibodies against the acetylcholine receptor. However, its effectiveness has only been proven a few years ago in a randomized controlled trial in patients under the age of 65. Here, we review the current literature focusing on patient subgroups, potential biomarkers for outcome prediction and the choice of surgical approach. Recent findings Long-term follow-up studies after thymectomy confirmed that the benefits regarding clinical outcome parameters and a reduced need for immunosuppressive treatment persist. Nevertheless, a substantial proportion of patients in real-world cohorts do not reach complete stable remission after thymectomy indicating that the underlying autoimmune process is sustained in the periphery. Our understanding of the responsible mechanisms has improved with recent studies. Presently, outcome data after thymectomy in several patient subgroups, such as those aged over 50 years, those with juvenile onset or those with purely ocular symptoms are limited and have been the focus of recent research activities. Similarly, biomarkers guiding an appropriate patient selection for thymectomy are under investigation. A number of cohort studies demonstrated that minimal invasive surgical techniques such as extended robotic thymectomy lead to similar positive outcomes as a transsternal approach with potentially fewer short-term adverse effects. Summary Thymectomy is an effective treatment option in adult patients with early onset acetylcholine-receptor positive myasthenia gravis but uncertainty remains with regard to certain patient subgroups.

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Section: Ocular Myasthenia Gravis and Thymectomymentioning

confidence: 80%

Thymectomy in myasthenia gravis

Rath,

Moser,

Zimprich

2023

Current Opinion in Neurology

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show abstract

“…Despite lacking a significant association of age at onset and sex with the presence of thymoma in univariate analysis, both factors were still included in the multivariate analysis owing to the results from previous literature showing a higher prevalence of thymoma in a younger age group and in females. 14 Nevertheless, multivariate analysis showed that an AChR antibody titer ≥15.12 nmol/L (OR 4.97, 95% CI: 1.10-22.48; p = 0.037) was the only significant factor associated with the presence of thymoma (Table 4).…”

mentioning

confidence: 97%

Significance of Acetylcholine Receptor Antibody Titers in Acetylcholine Receptor Antibody-Positive Ocular Myasthenia Gravis: Generalization and Presence of Thyroid Autoimmune Antibodies and Thymoma

Supawongwattana¹,

Vanikieti²,

Jindahra³

et al. 2023

OPTH

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To evaluate the association in acetylcholine receptor (AChR) antibody-positive ocular myasthenia gravis (OMG) subjects between AChR antibody titers and conversion to generalized myasthenia gravis (GMG), the presence of thyroid autoimmune antibodies, and the presence of thymoma. Subjects and Methods: A total of 118 subjects with AChR antibody-positive OMG were included. Demographic data, clinical characteristics, serology tests, presence of thymoma, treatment, and conversion to GMG were retrospectively reviewed. The presence of thyroid autoimmune antibodies was defined as the presence of at least one of the following: (1) thyroid peroxidase antibody; (2) thyroglobulin antibody; (3) thyroid-stimulating hormone receptor antibody. Univariate and multivariate logistic regression analyses were used as methods of evaluating association. Results: AChR antibody titers were determined in all subjects with a median of 3.33 (0.46-141.09) nmol/L. The median follow-up period was 14.5 (3-113) months. At the final follow-up time-point, 99 subjects (83.90%) remained with a diagnosis of pure OMG, while 19 subjects (16.10%) had converted to GMG. An AChR antibody titer ≥8.11 nmol/L was associated with the conversion to GMG (odds ratio (OR) 3.66, 95% CI: 1.19-11.26; p = 0.023). Of the 79 subjects with available thyroid autoimmune antibodies data, 26 subjects (32.91%) displayed the presence of thyroid autoimmune antibodies. An AChR antibody titer ≥2.81 nmol/L was associated with the presence of thyroid autoimmune antibodies (OR 6.16,; p = 0.004). Finally, of the 106 subjects with available thoracic computed tomography (CT) data, only 9 subjects (8.49%) demonstrated the presence of thymoma. An AChR antibody titer ≥15.12 nmol/L was associated with the presence of thymoma (OR 4.97, 95% CI: 1.10-22.48; p = 0.037). Conclusion:AChR antibody titers should be considered in AChR antibody-positive OMG patients. Those with AChR antibody titers ≥8.11 nmol/L, who are at a greater risk of conversion to GMG, should be closely monitored and encouraged to be aware of early clinical signs of life-threatening GMG. In addition, serum thyroid autoimmune antibodies and thoracic CT screening for thymoma should be performed in AChR antibody-positive OMG patients, particularly in those with AChR antibody titers ≥2.81 nmol/L and ≥15.12 nmol/L, respectively.

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Clinical Features, Treatment, and Prognostic Factors of Childhood-Onset Myasthenia Gravis in a Large Chinese Cohort

Zhang

et al. 2023

Pediatric Neurology

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Thymectomy in ocular myasthenia gravis—prognosis and risk factors analysis

Cited by 3 publications

References 34 publications

Thymectomy in myasthenia gravis

Thymectomy in myasthenia gravis

Significance of Acetylcholine Receptor Antibody Titers in Acetylcholine Receptor Antibody-Positive Ocular Myasthenia Gravis: Generalization and Presence of Thyroid Autoimmune Antibodies and Thymoma

Clinical Features, Treatment, and Prognostic Factors of Childhood-Onset Myasthenia Gravis in a Large Chinese Cohort

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