Effect of thymectomy in elderly patients with non-thymomatous generalized myasthenia gravis

Seung Woo Kim, Young Chul Choi, Seung Min Kim, Hyo Sup Shim, Ha Young Shin

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Abstract

Whether thymectomy is beneficial in elderly patients with myasthenia gravis (MG) is unclear. Thus, we assessed whether conducting thymectomy in MG patients aged ≥ 50 years is beneficial. This retrospective cohort study included patients with MG between 1990 and 2018. Thymectomy and control cohorts were selected from among the population of MG patients with an age at onset of ≥ 45 years and elevated concentrations of acetylcholine-receptor antibodies. Patients with evidence of thymic malignancy were excluded. Of these patients, those who underwent thymectomy at the age of ≥ 50 years were designated as the thymectomy group and those who received only medical treatment were designated as the medical treatment group. We compared the Myasthenia Gravis Foundation of America post-intervention status between the thymectomy and medical treatment groups. Landmark analysis was conducted with the landmark set at 24 months. A total of 34 and 105 patients were classified into the thymectomy and medical treatment groups, respectively. Before landmark analysis, the thymectomy group had a higher cumulative incidence of pharmacologic remission (p = 0.009) and complete stable remission (p = 0.022) than the medical treatment group. After landmark analysis, the thymectomy group had a 2.22-fold (95% confidence interval 1.01–4.80) increased chance of achieving pharmacologic remission compared to the medical treatment group after adjustment for age, sex, and disease severity. No significant difference was observed in the rate of relapse after pharmacological remission between the thymectomy (16.7%) and medical treatment groups (21.4%). In conclusion, thymectomy may have a beneficial effect in elderly patients with non-thymomatous generalized MG.

Original languageEnglish
Pages (from-to)960-968
Number of pages9
JournalJournal of Neurology
Volume266
Issue number4
DOIs
Publication statusPublished - 2019 Apr 4

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Thymectomy
Myasthenia Gravis
Therapeutics
Cholinergic Receptors
Age of Onset
Cohort Studies
Retrospective Studies
Pharmacology
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Kim, Seung Woo ; Choi, Young Chul ; Kim, Seung Min ; Shim, Hyo Sup ; Shin, Ha Young. / Effect of thymectomy in elderly patients with non-thymomatous generalized myasthenia gravis. In: Journal of Neurology. 2019 ; Vol. 266, No. 4. pp. 960-968.
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Effect of thymectomy in elderly patients with non-thymomatous generalized myasthenia gravis. / Kim, Seung Woo; Choi, Young Chul; Kim, Seung Min; Shim, Hyo Sup; Shin, Ha Young.

In: Journal of Neurology, Vol. 266, No. 4, 04.04.2019, p. 960-968.

Research output: Contribution to journalArticle

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