Randomized Trial of Thymectomy in Myasthenia Gravis

• Published in: The New England journal of medicine Vol. 375; no. 6; pp. 511 - 522
• Main Authors: Wolfe, Gil I, Kaminski, Henry J, Aban, Inmaculada B, Minisman, Greg, Kuo, Hui-Chien, Marx, Alexander, Ströbel, Philipp, Mazia, Claudio, Oger, Joel, Cea, J. Gabriel, Heckmann, Jeannine M, Evoli, Amelia, Nix, Wilfred, Ciafaloni, Emma, Antonini, Giovanni, Witoonpanich, Rawiphan, King, John O, Beydoun, Said R, Chalk, Colin H, Barboi, Alexandru C, Amato, Anthony A, Shaibani, Aziz I, Katirji, Bashar, Lecky, Bryan R.F, Buckley, Camilla, Vincent, Angela, Dias-Tosta, Elza, Yoshikawa, Hiroaki, Waddington-Cruz, Márcia, Pulley, Michael T, Rivner, Michael H, Kostera-Pruszczyk, Anna, Pascuzzi, Robert M, Jackson, Carlayne E, Garcia Ramos, Guillermo S, Verschuuren, Jan J.G.M, Massey, Janice M, Kissel, John T, Werneck, Lineu C, Benatar, Michael, Barohn, Richard J, Tandan, Rup, Mozaffar, Tahseen, Conwit, Robin, Odenkirchen, Joanne, Sonett, Joshua R, Jaretzki, Alfred, Newsom-Davis, John, Cutter, Gary R
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 11.08.2016
• Subjects: Adolescent; Adult; Aged; Azathioprine; Clinical trials; Combined Modality Therapy; Evidence-based medicine; Female; Glucocorticoids - administration & dosage; Hospitalization; Humans; Immunosuppression; Lymphatic system; Male; Middle Aged; Myasthenia; Myasthenia gravis; Myasthenia Gravis - classification; Myasthenia Gravis - drug therapy; Myasthenia Gravis - surgery; Neurological diseases; Neuromuscular diseases; Neuromuscular junctions; Patients; Prednisone; Prednisone - administration & dosage; Quality of life; Severity of Illness Index; Single-Blind Method; Surgery; Thymectomy; Treatment Outcome; Young Adult; United Kingdom > UK; United States > US
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1602489

In patients with nonthymomatous myasthenia gravis, thymectomy plus prednisone was associated with better clinical outcomes than prednisone alone. Patients treated with thymectomy had fewer hospitalizations for exacerbations and required lower prednisone doses. The first reported use of thymectomy in patients with nonthymomatous myasthenia gravis was 75 years ago. 1 Of six patients who underwent surgery, three had a favorable response. Subsequent retrospective studies have shown benefits of thymectomy in patients with nonthymomatous myasthenia gravis but with widely varying rates of clinical improvement or remission. A compilation of retrospective studies comparing surgery with medical management did not show a difference in remission rates. 2 Two studies that showed clinical improvements after thymectomy indicated that benefit occurred in the first few years after the procedure, but after 5 years, rates of clinical improvement were similar among . . .