Abstract summary 

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.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.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).Thymectomy improved clinical outcomes over a 3-year period in patients with nonthymomatous myasthenia gravis. (Funded by the National Institute of Neurological Disorders and Stroke and others; MGTX ClinicalTrials.gov number, NCT00294658.).

Authors & Co-authors:  Wolfe Gil I GI Kaminski Henry J HJ Aban Inmaculada B IB Minisman Greg G Kuo Hui-Chien HC Marx Alexander A Ströbel Philipp P Mazia Claudio C Oger Joel J Cea J Gabriel JG Heckmann Jeannine M JM Evoli Amelia A Nix Wilfred W Ciafaloni Emma E Antonini Giovanni G Witoonpanich Rawiphan R King John O JO Beydoun Said R SR Chalk Colin H CH Barboi Alexandru C AC Amato Anthony A AA Shaibani Aziz I AI Katirji Bashar B Lecky Bryan R F BR Buckley Camilla C Vincent Angela A Dias-Tosta Elza E Yoshikawa Hiroaki H Waddington-Cruz Márcia M Pulley Michael T MT Rivner Michael H MH Kostera-Pruszczyk Anna A Pascuzzi Robert M RM Jackson Carlayne E CE Garcia Ramos Guillermo S GS Verschuuren Jan J G M JJ Massey Janice M JM Kissel John T JT Werneck Lineu C LC Benatar Michael M Barohn Richard J RJ Tandan Rup R Mozaffar Tahseen T Conwit Robin R Odenkirchen Joanne J Sonett Joshua R JR Jaretzki Alfred A Newsom-Davis John J Cutter Gary R GR

Study Outcome 

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