Prevalence and clinical aspects of immigrants with myasthenia gravis in northern Europe

Boldingh, Marion Ingeborg; Maniaol, Angelina; Brunborg, Cathrine; Dekker, Luuk; Lipka, Alexander F.; Niks, Erik H.; Verschuuren, Jan J.; Tallaksen, Chantal

doi:10.1002/mus.25408

Cited by 16 publications

(9 citation statements)

References 27 publications

(34 reference statements)

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“…In agreement with previous findings, 13 we also observed a sex-related bias in our study, in that female patients outnumbered male patients. A majority of patients from both sexes had an EOMG; in the LOMG group, male patients outnumbered female patients, which is in line with the report by Al-Moallem et al 5 However, contrary to previous studies from the United States, Europe, and South Africa, and studies performed on Dutch and Norwegian patients that have consistently shown a bimodal peak of onset for females and a late single peak for males, 14 we did not observe a second peak of MG onset after 50 years of age in males or females in our cohort. This may be attributed either to environmental factors or to differences in ethnicity and racial composition.…”

Section: Resultssupporting

confidence: 88%

Clinical features and outcomes of patients with myasthenia gravis

Alanazy

2019

NSJ

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Objectives: To report clinical and laboratory features and outcomes of patients with autoimmune myasthenia gravis)MG(recruited from a single center in Saudi Arabia. Methods: We retrospectively reviewed prospectively collected data obtained from MG patients who have undergone examination and follow-up at our neuromuscular clinic between August 1, 2014 and January 31, 2019. Results: Ninety-five patients)55 females(were included. The mean age of onset of MG was 40.5±18.1 years in males and 31.3±15 years in females)p=0.009(. The mean duration of follow-up at our clinic was 34.7±14.1 months, while the mean duration since MG onset was 8.0±7.2 years. Of all patients, 92.6% had generalized MG, 82.1% had acetylcholine receptor)AChR(antibodies, 4.2% had muscle-specific tyrosine kinase)MuSK(antibodies, 78.9% had early-onset MG with no second peak after age of 50 years, 22.1% had myasthenia crisis, 12.6% had refractory MG, 31.6% had thymic hyperplasia, 10.5% had thymoma, and 61.1% required ≥2 immunosuppressive therapies. At the last follow-up, 93 patients had achieved an optimal outcome)MG Foundation of America classification ≤ II(. No patient with double-seronegative)dSN(-MG had thymoma, needed rituximab or intravenous immunoglobulin maintenance therapy, or was classified as refractory MG. Conclusion: Contrary to other studies, we did not observe a second-peak of MG onset. Clinical outcomes were favorable in the majority of our patients.

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Section: Resultssupporting

confidence: 88%

Clinical features and outcomes of patients with myasthenia gravis

Alanazy

2019

NSJ

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“…These data may further support the observation of a general increase in the incidence of autoimmune diseases in general and the high rate of autoimmune diseases in Israel in particular. As the pathogenesis of MG is thought to be influenced by a combination of genetic and environmental factors, 43‐45 one may speculate that our findings, also observed in other studies, 16‐18,22‐23,32‐36,38,46‐50 can be attributed to changes in environmental factors such as exposure to infective pathogens, diet, and contact with ecological compounds.…”

Section: Discussionsupporting

confidence: 86%

Incidence of AChR Ab‐positive myasthenia gravis in Israel: A population‐based study

et al. 2020

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Background The incidence of myasthenia gravis (MG) has traditionally been low, ranging between 2‐6/106. Several recent epidemiological studies have reported a higher incidence. We, therefore, aimed to assess and characterize the incidence of MG in Israel. Methods We retrospectively reviewed the records of all four laboratories that performed the acetylcholine receptor antibody (AChR Ab) test in Israel between 1994 and 2013 and documented the number of newly diagnosed seropositive MG patients each year. To assure that data indeed reflect only newly diagnosed patients, patient's names and ID numbers were screened at the Hadassah medical center database since 1978, the year when the test was first performed in Israel. In order to calculate the annual incidence of the disease, the population at risk was derived from the annual publication of the Israeli Central Bureau of Statistics. Results The annual incidence of MG for this time period was 13.1/106 inhabitants. The mean incidence of MG between 1994 and 2003 was 7.695/106/y, while the mean incidence between 2004 and 2013 was 18.49/106 (P < .0001). Mean age of diagnosis between 1994 and 2003 was 56.65 ± 0.9351, while between 2004 and 2013, it was 59.89 ± 0.5336 (P = .0012). Male to female (M:F) incidence ratio in the years 1994‐2003 and 2004‐2013 was 2:3.2 and 3:1.8, respectively, reflecting increased incidence among males (P < .0001). Conclusions The incidence of MG in Israel has increased significantly during the last decade, especially among males of older age. These findings may reflect an etiological role of an environmental factor, increased awareness, and increased longevity in general.

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“…If confirmed, a younger manifestation age may hint to an increased risk for thymoma and thymoma-associated MG development in Indians. In fact, the proportion of thymoma patients among MG patients was found to be higher in some Asian countries compared to Northern European countries ( 18 - 20 ).…”

Section: Discussionmentioning

confidence: 94%

GTF2I Mutation in Thymomas: Independence From Racial-Ethnic Backgrounds. An Indian/German Comparative Study

Jain

Guleria

Singh

et al. 2021

Pathol. Oncol. Res.

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Thymomas are the most frequent adult mediastinal cancers. Their etiology is unknown and their pathogenesis poorly understood. Racial, ethnic and environmental factors influence tumorigenesis in many cancers, but their role in thymomas remains unclear to date. In this study that included pretreatment thymoma cases from India and Germany (n = 37 and n = 77, respectively) we compared i) the prevalence of the thymoma-specific chromosome 7 c.74146970T > A mutation of the GTF2I gene in type A and AB thymomas; ii) epidemiological features; and iii) the frequency of myasthenia gravis (MG). Due to a known predominance of GTF2I mutation in A and AB histotypes, we included only a marginal number of type B thymomas as a control group in both cohorts. While the distribution of histological types between the cohorts was similar (p = 0.1622), Indian patients were strikingly younger (p < 0.0001; median age 50 vs. 65 years) and showed significantly lower tumour stage (Masaoka-Koga stage I) at primary diagnosis (p = 0.0005) than the German patients. In patients with known MG status (n = 17 in Indian and n = 25 in German cohort), a clear trend towards more frequent MG was observed in the Indian group (p = 0.0504; 48 vs. 82%). The prevalence of the GTF2I mutation (analysed in n = 34 Indian and n = 77 German patients) was identical in the two cohorts. We conclude that racial-ethnic and environmental factors do not significantly influence the most common molecular feature of thymomas but may have an impact on the timing of clinical presentation.

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Prevalence and clinical aspects of immigrants with myasthenia gravis in northern Europe

Abstract: Our findings indicate that Asian immigrant MG patients carry genetic factors or environmental/lifestyle factors which contribute to their specific phenotype, even after migration. Muscle Nerve 55: 819-827, 2017.

Cited by 16 publications

References 27 publications

Clinical features and outcomes of patients with myasthenia gravis

Clinical features and outcomes of patients with myasthenia gravis

Incidence of AChR Ab‐positive myasthenia gravis in Israel: A population‐based study

GTF2I Mutation in Thymomas: Independence From Racial-Ethnic Backgrounds. An Indian/German Comparative Study

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