Study Supports Surgery for Myasthenia Gravis

In a global study of myasthenia gravis, an autoimmune disease that causes muscle weakness and fatigue, researchers found that surgical removal of an organ called the thymus reduced patients’ weakness and their need for immunosuppressive drugs. The study, published in the New England Journal of Medicine, was partially funded by NIH.

“Our results support the idea that thymectomy is a valid treatment option for a major form of myasthenia gravis,” said a leader of the study, Dr. Gil Wolfe of Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, New York.

The Thymectomy Trial in Non-Thymomatous Myasthenia Gravis Patients Receiving Prednisone was a randomized, controlled study conducted on 126 patients ages 18-65 between 2006 and 2012. The researchers compared the combination of surgery and immunosuppression with the drug prednisone with prednisone treatment alone. They performed extended transsternal thymectomies on 57 patients. This major surgical procedure aims to remove most of the thymus, which requires opening of a patient’s chest.

On average, the researchers found that the combination of surgery and prednisone treatment reduced overall muscle weakness more than prednisone treatment alone. 

The researchers also found that patients who had surgery required lower daily doses of prednisone than the patients receiving prednisone alone. They had less need for additional immunosuppressant drugs as well.  

“This is a study that the myasthenia gravis community has needed for a long time,” said Dr. Robin Conwit, NINDS program director. “We hope it becomes a model for rigorously testing other treatment options.”