Document Detail


A comparison of long-term post-thymectomy outcome of anti-AChR-positive, anti-AChR-negative and anti-MuSK-positive patients with non-thymomatous myasthenia gravis.
MedLine Citation:
PMID:  19063688     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: A single-centre, non-randomized, non-controlled study was designed to compare the long-term post-thymectomy clinical outcome in anti-AChR-positive, anti-AChR-negative and anti-MuSK-positive patients with non-thymomatous myasthenia gravis (MG). METHODS: A total of 331 consecutive patients with seropositive MG, 55 with seronegative MG and 10 with anti-MuSK-positive MG underwent extended transsternal thymectomy (T-3b according to Myasthenia Gravis Foundation of America). The primary endpoint was to assess differences in the rate of complete stable remission (CSR) in patients with and without anti-AChR and anti-MuSK antibodies. RESULTS: The mean follow-up was 218.3 (SD 128.1) months in the seropositive MG group, 149.8 (SD 131.1) in the seronegative group and 169.9 (SD 116) in the anti-MuSK-positive group. In the seropositive MG group, the probability of obtaining CSR at 5 years post-thymectomy was 51.1% for the seropositive group compared with 40 for the seronegative group (p = 0.05) and 20 for the anti-MuSK-positive group (p = 0.03). Differences between the seronegative and anti-MuSK-positive groups were not observed. The estimated median follow-up to obtain a CSR was 17.8 months (95% confidence interval [CI] 15.7 - 19.8 months) in seropositive MG patients, 22.1 (95% CI 16.7 - 27.4 months) in seronegative MG patients and 20.6 (95% CI 13.3 - 27.9 months) in anti-MuSK-positive MG patients (long-rank test, p = 0.07). CONCLUSIONS: Long-term post- thymectomy clinical outcome was better in patients with conventional anti-AChR antibodies than in those with seronegative disease. In seronegative anti-MuSK-positive MG, thymectomy seems to be less effective than in anti-MuSK-negative MG but this study cannot answer the question of whether thymectomy should be undertaken in anti-MuSK-positive patients.
Authors:
José M Ponseti; Norma Caritg; Josep Gamez; Manuel López-Cano; Ramón Vilallonga; Manuel Armengol
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Expert opinion on biological therapy     Volume:  9     ISSN:  1744-7682     ISO Abbreviation:  Expert Opin Biol Ther     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-09     Completed Date:  2009-01-13     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  101125414     Medline TA:  Expert Opin Biol Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  1-8     Citation Subset:  IM    
Affiliation:
Unit of Myasthenia Gravis, Autonomous University of Barcelona, Hospital General Universitari Vall d'Hebron, Department of Surgery, Barcelona, Spain. jmponseti@vhebron.net
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Child
Female
Humans
Male
Middle Aged
Myasthenia Gravis / immunology,  surgery*
Receptor Protein-Tyrosine Kinases / immunology*
Receptors, Cholinergic / immunology*
Retrospective Studies
Thymectomy*
Chemical
Reg. No./Substance:
0/Receptors, Cholinergic; EC 2.7.10.1/MUSK protein, human; EC 2.7.10.1/Receptor Protein-Tyrosine Kinases

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