Low conversion rate of ocular to generalized myasthenia gravis in Singapore

Teo, Kelvin; Tow, Sharon; Haaland, Benjamin; Gosavi, Tushar Divakar; Jing-Liang, Loo; Long, Lo Yew; Miléa, Dan

doi:10.1002/mus.25983

Cited by 31 publications

(69 citation statements)

References 39 publications

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“…Contrast to 90% of conversion rate without immunosuppressive treatments, only 38 patients (17.0%) of 223 OMG patients under sufficient immunosuppressive treatments converted to GMG in the present study. This result was consistent with previous studies which compared the conversion rate of the immunosuppressed group and the non-immunosuppressed group [6,7,13,14]. Yet the predictors for these patients who received early immunosuppressive therapy still remain unknown.…”

Section: Discussionsupporting

confidence: 92%

“…Whether positive RNS result could predict GMG conversion has not yet been completely elucidated. Previous reports indicated positive RNS could predict higher conversion rate [6,7]. Whereas other studies did not support this [1,4,6,22].…”

Section: Discussionmentioning

confidence: 87%

“…To date, a series of predictors have been postulated to affect conversion rates. Both in Korean and Singapore, repetitive nerve stimulation (RNS) tests and antiacetylcholine receptor antibody (AChR-Ab) could be predictive factors for conversion of OMG to GMG [6,7]. While in a Germany study, the scholar deemed the presence of thymoma was the only risk factor for secondary generalization [8].…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies suggested immunosuppressive treatments could reduce the conversion rate of OMG to 7% -24% [6,7,9], but a portion of patients still ineluctably converted. The predictors for these patients require further investigation.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of myasthenia gravis generalization under immunosuppressive therapy in Northwest China

Ding

Zhao

Ren

et al. 2020

Preprint

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Objective It is well demonstrated that immunosuppressants can reduce, but not eliminate the risk of generalized development in ocular myasthenia gravis (OMG). Herein, we explored the potential predictors of conversion of OMG patients receiving immunosuppressive treatments. Methods OMG patients under immunosuppressive treatments in Tangdu Hospital from June 2008 to June 2012 were retrospectively reviewed. Baseline clinical characteristics were documented. Patients were followed up regularly by face-to-face interview to evaluate clinic status and treatment efficacy. Main outcome measure was generalized conversion and the relative data were collected and analyzed by logistic regression. Results 223 eligible OMG patients completed the final follow-up visit and 38 (17.0%) progressed to generalized MG (GMG) at a median interval of 0.9 year. Patients with adult onset and positive repetitive nerve stimulation (RNS) of facial or axillary nerve had higher conversion rate than those with juvenile onset and negative RNS ( p = 0.001; p = 0.019; p = 0.015, respectively). Adult-onset patients converted earlier than juvenile-onset OMG patients ( p = 0.014). Upon multivariate logistic regression analysis, age of onset (Odds ratio [OR] 1.023, 95% confidence interval [CI] 1.006–1.041, p = 0.007) and positive facial nerve RNS (OR 2.826, 95%CI 1.045–5.460, p = 0.038) were found to be positively associated with generalized development. Moreover, an obviously negative association was found for disease duration (OR 0.603, 95%CI 0.365–0.850, p = 0.019). Conclusions Age of onset, disease duration and facial nerve RNS test can predict conversion of OMG under immunosuppressive treatment. Adult-onset, shorter disease duration and facial nerve RNS-positive patients have a higher risk of generalized development.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prediction of myasthenia gravis generalization under immunosuppressive therapy in Northwest China

Ding

Zhao

Ren

et al. 2020

Preprint

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“…In Asia, the conversion rate was much lower due to the large proportion of juvenile-onset MG and the relative lower conversion rate (12.4-19.9%) [11,12]. Previous studies had revealed certain risk factors for OMG conversion, including older onset age, increased anti-ace-tylcholine receptor antibody (anti-AChR Ab) titer, presence of decrement on repetitive nerve stimulation (RNS), thymoma, and daily-life quality impairment due to the ocular symptoms [7,10,[13][14][15]. However, most studies recruited OMG patients with a wide age spectrum and did not filter out the potential confounding effect of immunosuppressing therapy.…”

Section: Introductionmentioning

confidence: 99%

Adult Ocular Myasthenia Gravis Conversion: A Single-Center Retrospective Analysis in China

et al. 2020

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Introduction: The conversion rate from ocular myasthenia gravis (OMG) to generalized myasthenia gravis (GMG) was reported to be much lower in Asian population since most OMG patients are juvenile onset. However, the exact conversion rate for adult-onset OMG to GMG is still unknown. Objective: We aimed to delineate the conversion rate and risk factors for adult patients with ocular onset to GMG. Methods: Adult myasthenia gravis (MG) patients with ocular onset (age > 18 years) were retrospectively reviewed. Patients with confined ocular involvement lasting more than 2 years (pure OMG group) and those who converted into GMG (converted OMG group) were enrolled for subsequent analysis. We then analyzed 5 clinical variables, including onset age, sex, onset symptoms, anti-acetylcholine receptor antibody (AChR Ab), and thymus CT. Survival analysis was applied to all enrolled patients to explore risk factors associated with conversion. Results: In a total number of 249 ocular-onset MG patients initially enrolled, we excluded 122 patients with OMG lasting less than 2 years. The remaining 127 patients were enrolled, including 106 converted OMG and 21 pure OMG patients. Converted OMG patients had an older onset age (threshold: 43 years) and higher anti-AChR Ab titer (threshold: 6.13 nmol/L). The estimated conversion rate was 70.64%. Moreover, 67% of conversion occurred within 2 years after onset. Cox regression of survival analysis revealed that higher anti-AChR Ab titer and bilateral ptosis were associated with a higher conversion rate. Conclusions: The conversion of adult OMG was associated with anti-AChR Ab titer, onset age, and bilateral ptosis. The estimated conversion rate of Chinese adult OMG patients was 70%.

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Clinical characteristics of anti‐AChR‐MuSK‐LRP4 antibody‐negative myasthenia gravis in China

Cui

et al. 2023

Muscle and Nerve

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Low conversion rate of ocular to generalized myasthenia gravis in Singapore

Abstract: The conversion rate of OMG to GMG in Asian patients is low, as predicted by presence of acetylcholine receptor antibodies, presence of thymoma, and positive RNS studies. Muscle Nerve 57: 756-760, 2018.

Cited by 31 publications

References 39 publications

Prediction of myasthenia gravis generalization under immunosuppressive therapy in Northwest China

Prediction of myasthenia gravis generalization under immunosuppressive therapy in Northwest China

Adult Ocular Myasthenia Gravis Conversion: A Single-Center Retrospective Analysis in China

Clinical characteristics of anti‐AChR‐MuSK‐LRP4 antibody‐negative myasthenia gravis in China

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