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Randomized Trial of Thymectomy in Myasthenia Gravis

Monday, August 15, 2016

Submitted by

Aristotle Protopapas

Source

Source Name: New England Journal of Medicine

Source URL: http://www.nejm.org/doi/full/10.1056/NEJMoa1602489#t=article

Author(s)

Wolfe GI, Kaminski HJ, Aban IB, Minisman G, Kuo HC, Marx A, Ströbel P, Mazia C, Oger J, Cea JG, Heckmann JM, Evoli A, Nix W, Ciafaloni E, Antonini G, Witoonpanich R, King JO, Beydoun SR, Chalk CH, Barboi AC, Amato AA, Shaibani AI, Katirji B, Lecky BR, Buckley C, Vincent A, Dias-Tosta E, Yoshikawa H, Waddington-Cruz M, Pulley MT, Rivner MH, Kostera-Pruszczyk A, Pascuzzi RM, Jackson CE, Garcia Ramos GS, Verschuuren JJ, Massey JM, Kissel JT, Werneck LC, Benatar M, Barohn RJ, Tandan R, Mozaffar T, Conwit R, Odenkirchen J, Sonett JR, Jaretzki A 3rd, Newsom-Davis J, Cutter GR; MGTX Study Group.

A small international prospective randomized trial of extended thymectomy with steroids vs steroids for 126 with class II to IV myasthenia gravis. The selection criteria and powering were altered mid-trial. Surgery was associated with a better symptom score, lower dose of predisone, less use of immunosuppresives, and fewer hospitalizations at 3 years. The positive outcomes are of surgical relevance as they may lead to a considerable increase of referrals for OPEN thymectomies! I assume that longer term outcomes will be forthcoming.