Thymectomy plus prednisone confers benefit versus prednisone alone at 5 years in myasthenia gravis
WEDNESDAY, Jan. 30, 2019 (HealthDay News) — For patients with non-thymomatous myasthenia gravis, thymectomy plus prednisone confers benefits versus prednisone alone at five years, according to a study published online Jan. 25 in The Lancet Neurology.
Gil I. Wolfe, M.D., from the University at Buffalo Jacobs School of Medicine and Biomedical Sciences in New York, and colleagues examined the effects of thymectomy for up to five years on clinical status, medication requirements, and adverse events. Participants included 111 patients who were randomly assigned to thymectomy plus prednisone or prednisone alone as part of the three-year Thymectomy Trial in Non-Thymomatous Myasthenia Gravis Patients Receiving Prednisone; 68 entered a two-year extension study at 36 centers in 15 countries. Fifty patients completed the 60-month assessment: 26 and 24, respectively, in the thymectomy plus prednisone and prednisone-alone groups.
The researchers found that compared with those in the prednisone-alone group, patients in the thymectomy plus prednisone group had significantly lower time-weighted mean Quantitative Myasthenia Gravis scores (5.47 versus 9.34) and mean alternate-day prednisone doses (24 versus 48 mg) at five years. By month 60, 34 and 42 percent of patients, respectively, in the thymectomy and prednisone and prednisone-alone groups had at least one adverse event. During the extension phase, there were no reports of treatment-related deaths.
“Our results should lead to revision of clinical guidelines in favor of thymectomy and could potentially reverse downward trends in the use of thymectomy in overall management of myasthenia gravis,” the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.
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