Publication:
Randomized trial of thymectomy in myasthenia gravis

Issued Date

2016-08-11

Resource Type

Article

ISSN

15334406
00284793

DOI

10.1056/NEJMoa1602489

Other identifier(s)

2-s2.0-84981743104

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

New England Journal of Medicine. Vol.375, No.6 (2016), 511-522

Suggested Citation

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 Randomized trial of thymectomy in myasthenia gravis. New England Journal of Medicine. Vol.375, No.6 (2016), 511-522. doi:10.1056/NEJMoa1602489 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/41229

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Title

Randomized trial of thymectomy in myasthenia gravis

Author(s)

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

Other Contributor(s)

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

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.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/123456789/41229

Collections

Scopus 2016-2017