Remission and relapses of myasthenia gravis on long-term tacrolimus: a retrospective cross-sectional study of a Chinese cohort

Bi, Zhuajin; Cao, Yayun; Liu, Chenchen; Gui, Mengcui; Lin, Jing; Zhang, Qing; Li, Yue; Ji, Suqiong; Bu, Bitao

doi:10.1177/20406223221122538

Cited by 8 publications

(4 citation statements)

References 28 publications

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“…28 Furthermore, after a median follow-up of 2.9 years, a signi cant proportion of patients may discontinue prednisone, and some achieve complete stable remission. 29 Overall, these ndings highlight the potential bene ts of thymectomy in the management of MG and support the outcomes observed in our study.…”

Section: Discussionsupporting

confidence: 89%

Thoracoscopic Thymectomy for Myasthenia Gravis: An early experience in Yemen

Obadiel,

Al-Shehari,

Al-Shawesh

et al. 2024

Preprint

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Background Thymectomy is an option for the treatment of myasthenia gravis MG. While the open technique was most frequently performed in the past, nowadays the endoscopic approach has gained wide acceptance. Here we assessed our early experience in thoracoscopic thymectomy (TT).Methods This case series was retrospectively conducted at Al-Thawra Modern General Hospital and included patients diagnosed with MG who underwent TT from January 2018 to January 2024.Results Our case series consisted of 13 predominantly female patients (61.5%), with a median age of 39.5 years. The most common presenting symptoms were generalized weakness and ptosis. Surgeries typically lasted 50 ± 10.41 minutes, with the majority performed using a left-sided thoracoscopic approach (n = 10, 77%). Immediate extubation was achieved in 10 patients (76%). Four patients experienced early postoperative complications (31%), including dyspnea, prolonged intubation, chest infection, confusion, tracheostomy, and re-tracheostomy. There were 2 recorded deaths due to complications. Eleven patients were followed up for an average of 16.5 months, revealing that 54.5% achieved complete stable remission, 18% showed improvement with reduced symptoms and medications, and 27% remained unchanged.Conclusions Thoracoscopic thymectomy is a safe and effective procedure for the management of MG in Yemeni patients. The observed remission and improvement rates are promising and align with global experiences. It is recommended that with proper resources and expertise, similar minimally invasive surgical approaches can be implemented in resource-limited regions.

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Section: Discussionsupporting

confidence: 89%

Thoracoscopic Thymectomy for Myasthenia Gravis: An early experience in Yemen

Obadiel,

Al-Shehari,

Al-Shawesh

et al. 2024

Preprint

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“…This was a retrospective study, examining the clinical records of all GMG patients with an onset age of over 18 years who were diagnosed and treated at the Neurologic Department of Tongji Hospital from January 1989 to May 2021. The diagnosis of GMG, as previously described, was based on fluctuating generalized muscle fatigability together with a positive result on one or more of the neostigmine, repetitive nerve stimulation (RNS), and AChR-ab tests ( 7 ). All patients were well controlled and had achieved stable status, which was defined as achieving minimal manifestation status (MMS) for at least 3 months.…”

Section: Methodsmentioning

confidence: 99%

“…To investigate factors that may potentially result in a first exacerbation from stable status, the patients were divided into two groups based on whether they experienced MG exacerbations throughout the study: the exacerbation group and the non-exacerbation group. MG exacerbation was defined as the reappearance or worsening of any symptoms or signs of generalized muscle weakness lasting more than 24 h ( 7 , 9 ).…”

Section: Methodsmentioning

confidence: 99%

“…The serum status of AChR-ab was estimated by enzyme-linked immunosorbent assay (ELISA) (RSR Limited, Cardiff, UK), MuSK-ab by radioimmunoassay (RIA) (RSR Limited, Cardiff, UK), Titin-ab by ELISA (DLD, Hamburg, Germany), and LRP4-ab by cell-based assays (CBA) as previously described ( 7 , 10 ). AChR-ab titers > 0.50 nmol/L and MuSK-ab titers > 0.05 nmol/L were regarded as positive (RIA kit, RSR Limited).…”

Section: Methodsmentioning

confidence: 99%

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Clinical and immune-related factors associated with exacerbation in adults with well-controlled generalized myasthenia gravis

Zhan

Zhang

et al. 2023

Front. Immunol.

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ObjectivesTo describe the clinical predictors and immune-related factors for exacerbation in adults with well-controlled generalized myasthenia gravis (GMG).MethodsWe conducted a retrospective analysis of 585 adults with well-controlled GMG from our institution to explore the risk factors for exacerbation. Furthermore, propensity score matching (PSM) was used to compare the proportions of lymphocyte subsets, and the levels of immunoglobulin, complement, and anti-acetylcholine receptor antibody (AChR-ab) in the peripheral blood of 111 patients with exacerbations and 72 patients without exacerbations.ResultsA total of 404 patients (69.1%) experienced at least one exacerbation, and the median (interquartile range) time to the first exacerbation was 1.5 years (0.8–3.1 years). Multivariable Cox regression analysis showed that age at onset, disease duration before enrollment, Myasthenia Gravis Foundation of America classification (MGFA) class III vs. class II, MGFA class IV-V vs. class II, AChR-ab levels, anti-muscle specific kinase antibody levels, thymus hyperplasia, prednisone plus immunosuppressants vs. prednisone treatment, and thymectomy were independent predictors for exacerbations [hazard ratio (HR) = 1.011, 1.031, 1.580, 1.429, 2.007, 2.033, 1.461, 0.798, and 0.651, respectively]. Propensity-matched analysis compared 51 patient pairs. After PSM, the peripheral blood proportions of CD3–CD19+ B cells, ratios of CD3+CD4+/CD3+CD8+ T cells, and AChR-ab levels were significantly increased, and the peripheral blood proportions of CD3+CD8+ T and CD4+CD25+CD127low+ regulatory T cells (Tregs) were significantly lower in patients with exacerbation than in those without exacerbation (all p < 0.05).ConclusionMyasthenia gravis (MG) exacerbations were more frequent in those patients with older onset age, longer disease duration, more severe MGFA classification, positive AChR-ab, and lack of combined immunotherapy or thymectomy treatment. On the other hand, CD3–CD19+ B cells, CD3+CD8+ T cells, Tregs, and AChR-ab in peripheral blood may be involved in the course of GMG exacerbation.

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