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Title: Randomized trial of thymectomy in myasthenia gravis
Authors: G. I. Wolfe
H. J. Kaminski
I. B. Aban
G. Minisman
H. C. Kuo
A. Marx
P. Ströbel
C. Mazia
J. Oger
J. G. Cea
J. M. Heckmann
A. Evoli
W. Nix
E. Ciafaloni
G. Antonini
R. Witoonpanich
J. O. King
S. R. Beydoun
C. H. Chalk
A. C. Barboi
A. A. Amato
A. I. Shaibani
B. Katirji
B. R.F. Lecky
C. Buckley
A. Vincent
E. Dias-Tosta
H. Yoshikawa
M. Waddington-Cruz
M. T. Pulley
M. H. Rivner
A. Kostera-Pruszczyk
R. M. Pascuzzi
C. E. Jackson
G. S. Garcia Ramos
J. J.G.M. Verschuuren
J. M. Massey
J. T. Kissel
L. C. Werneck
M. Benatar
R. J. Barohn
R. Tandan
T. Mozaffar
R. Conwit
J. Odenkirchen
J. R. Sonett
A. Jaretzki
J. Newsom-Davis
G. R. Cutter
University at Buffalo, State University of New York
University of Rochester Medical Center
Columbia University Medical Center
George Washington University School of Medicine and Health Sciences
University of Alabama at Birmingham
Universitatsklinikum Mannheim
Universität Göttingen
Johannes Gutenberg Universität Mainz
Universidad de Buenos Aires
The University of British Columbia
McGill University
Universidad de Chile
University of Cape Town
Università Cattolica del Sacro Cuore, Rome
Università degli Studi di Roma La Sapienza
Mahidol University
University of Melbourne
University of Southern California
UCI Medical Center
Medical College of Wisconsin
Harvard Medical School
Nerve and Muscle Center of Texas
University of Texas Health Science Center at San Antonio
Case Western Reserve University
Ohio State University
Walton Centre for Neurology and Neurosurgery NHS Trust
University of Oxford
Universidade de Brasilia
Universidade Federal do Rio de Janeiro
Universidade Federal do Parana
Kanazawa University
University of Florida
University of Miami Leonard M. Miller School of Medicine
Augusta University
Medical University of Warsaw
Indiana School of Medicine
Instituto Nacional de la Nutricion Salvador Zubiran
Leiden University Medical Center - LUMC
Duke University Medical Center
University of Kansas Medical Center
University of Vermont College of Medicine
National Institute of Neurological Disorders and Stroke
Keywords: Medicine
Issue Date: 11-Aug-2016
Citation: New England Journal of Medicine. Vol.375, No.6 (2016), 511-522
Abstract: Copyright © 2016 Massachusetts Medical Society. BACKGROUND: Thymectomy has been a mainstay in the treatment of myasthenia gravis, but there is no conclusive evidence of its benefit. We conducted a multicenter, randomized trial comparing thymectomy plus prednisone with prednisone alone. METHODS: We compared extended transsternal thymectomy plus alternate-day prednisone with alternate-day prednisone alone. Patients 18 to 65 years of age who had generalized nonthymomatous myasthenia gravis with a disease duration of less than 5 years were included if they had Myasthenia Gravis Foundation of America clinical class II to IV disease (on a scale from I to V, with higher classes indicating more severe disease) and elevated circulating concentrations of acetylcholine-receptor antibody. The primary outcomes were the time-weighted average Quantitative Myasthenia Gravis score (on a scale from 0 to 39, with higher scores indicating more severe disease) over a 3-year period, as assessed by means of blinded rating, and the time-weighted average required dose of prednisone over a 3-year period. RESULTS: A total of 126 patients underwent randomization between 2006 and 2012 at 36 sites. Patients who underwent thymectomy had a lower time-weighted average Quantitative Myasthenia Gravis score over a 3-year period than those who received prednisone alone (6.15 vs. 8.99, P<0.001); patients in the thymectomy group also had a lower average requirement for alternate-day prednisone (44 mg vs. 60 mg, P<0.001). Fewer patients in the thymectomy group than in the prednisone-only group required immunosuppression with azathioprine (17% vs. 48%, P<0.001) or were hospitalized for exacerbations (9% vs. 37%, P<0.001). The number of patients with treatment-associated complications did not differ significantly between groups (P=0.73), but patients in the thymectomy group had fewer treatment-associated symptoms related to immunosuppressive medications (P<0.001) and lower distress levels related to symptoms (P=0.003). CONCLUSIONS: Thymectomy improved clinical outcomes over a 3-year period in patients with nonthymomatous myasthenia gravis.
ISSN: 15334406
Appears in Collections:Scopus 2016-2017

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