@article{2e11ef0e9a2d40d5a6caa76bfc41bed7,
title = "Randomized trial of thymectomy in myasthenia gravis",
abstract = "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.",
keywords = "Glucocorticoids, Hospitalization, Humans, Male, Medicine (all), Middle Aged, Myasthenia Gravis, Prednisone, Severity of Illness Index, Single-Blind Method, Thymectomy, Treatment Outcome, Young Adult, Glucocorticoids, Hospitalization, Humans, Male, Medicine (all), Middle Aged, Myasthenia Gravis, Prednisone, Severity of Illness Index, Single-Blind Method, Thymectomy, Treatment Outcome, Young Adult",
author = "Wolfe, \{G. I.\} and Kaminski, \{H. J.\} and Aban, \{I. B.\} and G. Minisman and Kuo, \{H. C.\} and A. Marx and P. Str{\"o}bel and C. Mazia and J. Oger and Cea, \{J. G.\} and Heckmann, \{J. M.\} and \{Evoli Stampanoni-B\}, Amelia and W. Nix and E. Ciafaloni and G. Antonini and R. Witoonpanich and King, \{J. O.\} and Beydoun, \{S. R.\} and Chalk, \{C. H.\} and Barboi, \{A. C.\} and Amato, \{A. A.\} and Shaibani, \{A. I.\} and B. Katirji and Lecky, \{B. R.F.\} and C. Buckley and A. Vincent and E. Dias-Tosta and H. Yoshikawa and M. Waddington-Cruz and Pulley, \{M. T.\} and Rivner, \{M. H.\} and A. Kostera-Pruszczyk and Pascuzzi, \{R. M.\} and Jackson, \{C. E.\} and \{Garcia Ramos\}, \{G. S.\} and Verschuuren, \{J. J.G.M.\} and Massey, \{J. M.\} and Kissel, \{J. T.\} and Werneck, \{L. C.\} and M. Benatar and Barohn, \{R. J.\} and R. Tandan and T. Mozaffar and R. Conwit and J. Odenkirchen and Sonett, \{J. R.\} and A. Jaretzki and J. Newsom-Davis and Cutter, \{G. R.\}",
year = "2016",
doi = "10.1056/NEJMoa1602489",
language = "English",
volume = "375",
pages = "511--522",
journal = "THE NEW ENGLAND JOURNAL OF MEDICINE",
issn = "0028-4793",
publisher = "Boston: Massachusetts Medical Society",
}