Objective
To determine a predictive factor for the risk of conversion from ocular myasthenia gravis (
OMG
) to generalized
MG
(
GMG
) in a prospective study.
Methods
RNA
was isolated from serum samples and detection of micro
RNA
(mi
RNA
) expression analyzed with
qPCR
. In the discovery set, 179 human mi
RNA
s were assayed for profiling of five
OMG
patients and four age‐ and gender‐matched healthy controls. Based on the specific accumulation pattern of 19 mi
RNA
s from the discovery set, in addition to mi
RNA
s previously found elevated in generalized
MG
(
GMG
; miR‐150‐5p and miR‐30e‐5p), 21 mi
RNA
s were subsequently analyzed in a validation cohort of 83
OMG
patients (82 immunosuppression treatment naive; 49 male) within 3 months of diagnosis and at a follow‐up visit (median duration 28 months from first visit).
Results
Thirteen patients generalized 14.8 ± 12.0 months after the diagnosis and the majority (85%) belonged to the late onset
MG
group. Two mi
RNA
s were significantly higher in secondary
GMG
(
SGMG
) patients compared to
OMG
patients with late onset
MG
: miR‐30e‐5p (9.1 ± 0.5 vs. 6.3 ± 0.9;
P
< 0.0001) and miR‐150‐5p (7.4 ± 1.1 vs. 6.4 ± 1.1;
P
= 0.01). The sensitivity for miR‐30e‐5p in differentiating
OMG
and
SGMG
was 96% in all
OMG
patients and 100% in late onset
OMG
patients.
Interpretation
This is the first study to describe a potential predictive factor associated with the risk of generalization for patients with
OMG
. Raised levels (>8) of miR‐30e‐5p at initial presentation in patients with ocular
MG
symptoms, give a predictive cut‐off for subsequent generalization of 96–100%.
There are no biomarkers for late onset myasthenia gravis (LOMG; onset >50 years). We evaluated circulating microRNA in a discovery cohort of 4 LOMG patients and 4 healthy controls and in a prospective diagnostic validation cohort of 73 LOMG patients (48 male) with longitudinal follow-up samples. In immunosuppression naïve patients, levels of miRNAs miR-150-5p, miR-21-5p and miR-30e-5p decreased in parallel with clinical improvement after initiation of immunosuppression and their levels positively correlated with the clinical MG composite score. Levels of miR-150-5p and miR-21-5p were lower in patients with ocular compared to generalized LOMG. Circulating miR-150-5p, miR-21-5p and miR-30e-5p correlate with the clinical course in LOMG.
The terminal complement inhibitor eculizumab was shown to improve myasthenia gravis-related symptoms in the 26-week, phase 3, randomized, double-blind, placebo-controlled REGAIN study (NCT01997229). In this 52week sub-analysis of the open-label extension of REGAIN (NCT02301624), eculizumab's efficacy and safety were assessed in 11 Japanese and 88 Caucasian patients with anti-acetylcholine receptor antibody-positive refractory generalized myasthenia gravis. For patients who had received placebo during REGAIN, treatment with openlabel eculizumab resulted in generally similar outcomes in the Japanese and Caucasian populations. Rapid improvements were maintained for 52 weeks, assessed by change in score from open-label extension baseline to week 52 (mean [standard error]) using the following scales (in Japanese and Caucasian patients, respectively): Myasthenia Gravis Activities of Daily Living (−2.4 [1.34] and − 3.3 [0.65]); Quantitative Myasthenia Gravis (−2.9 [1.98] and − 4.3 [0.79]); Myasthenia Gravis Composite (−4.5 [2.63] and − 4.9 [1.19]); and Myasthenia Gravis Quality of Life 15-item questionnaire (−8.6 [5.68] and − 6.5 [1.93]). Overall, the safety of eculizumab was consistent with its known safety profile. In this interim sub-analysis, the efficacy and safety of eculizumab in Japanese and Caucasian patients were generally similar, and consistent with the overall REGAIN population.
Objective
To assess whether eculizumab, a terminal complement inhibitor, improves patient‐ and physician‐reported outcomes (evaluated using the myasthenia gravis activities of daily living profile and the quantitative myasthenia gravis scale, respectively) in patients with refractory anti‐acetylcholine receptor antibody‐positive generalized myasthenia gravis across four domains, representing ocular, bulbar, respiratory, and limb/gross motor muscle groups.
Methods
Patients with refractory anti‐acetylcholine receptor antibody‐positive generalized myasthenia gravis were randomized 1:1 to receive either placebo or eculizumab during the REGAIN study (NCT01997229). Patients who completed REGAIN were eligible to continue into the open‐label extension trial (NCT02301624) for up to 4 years. The four domain scores of each of the myasthenia gravis activities of daily living profile and the quantitative myasthenia gravis scale recorded throughout REGAIN and through 130 weeks of the open‐label extension were analyzed.
Results
Of the 125 patients who participated in REGAIN, 117 enrolled in the open‐label extension; 61 had received placebo and 56 had received eculizumab during REGAIN. Patients experienced rapid improvements in total scores and all four domain scores of both the myasthenia gravis activities of daily living profile and the quantitative myasthenia gravis scale with eculizumab treatment. These improvements were sustained through 130 weeks of the open‐label extension.
Interpretation
Eculizumab treatment elicits rapid and sustained improvements in muscle strength across ocular, bulbar, respiratory, and limb/gross motor muscle groups and in associated daily activities in patients with refractory anti‐acetylcholine receptor antibody‐positive generalized myasthenia gravis.
BackgroundStiff Person Syndrome (SPS) is an autoimmune condition involving antibodies against several components of the inhibitory synapse in the spinal cord, with Glutamic Acid Decarboxylase (GAD) antibodies being the predominant immune marker. SPS affects approximately 1 patient per million population per year. The effect of IVIG has been established but studies on long term efficacy of regular IVIG are limited.
ObjectivesReview clinical details and long-term treatment response using a patient-reported questionnaire in stiff person and related syndromes.
MethodsPatients were identified from a tertiary neuroimmunology clinic based on classical clinical symptoms, autoimmune profile, and neurophysiological changes (Dalakas criteria). They were followed up after treatment to assess the response to IVIG.
Results
patients fulfilled the selection criteria. Patients' demographic profiles and clinical
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