Myasthenia gravis patients fare better with surgery than drugs

Myasthenia gravis, an autoimmune disease that causes fatigue and muscle weakness, has typically been treated with drugs, but a team of researchers examined if surgery may offer better outcomes.

In a study of 126 patients, ages 18 to 65, over the course of six years, researchers tested the theory that the surgical removal of the thymus could reduce that patients muscle weakness and need for immunosuppressive drugs. The results of the study were published in the New England Journal of Medicine.

“Our results support the idea that thymectomy is a valid treatment option for a major form of myasthenia gravis,” said Gil Wolfe, MD, professor at the University at Buffalo, New York, and lead author of the study.

The study split the patient into those receiving both surgery and the immunosuppressive drug prednisone and those receiving only prednisone. Both sets of patients, after 36 months on prednisone, showed better muscle strength. But the patients that received the surgery as well fared much better. Patients that received both a surgical thymectomy and prednisone required lower daily doses of the drug and reduced the rate of adverse events from 93 to 48.

“This is a study that the myasthenia gravis community has needed for a long time,” said Robin Conwit, MD, program director at NIH’s National Institute of Neurological Disorders and Stroke (NINDS). “We hope it becomes a model for rigorously testing other treatment options.”

“Our results suggest surgery is a legitimate option for patients to consider,” said Gil Wolfe, MD, another author on the study. “We hope that it will help doctors and patients weigh the costs and benefits of how best to reduce the disability that may impact myasthenia gravis patients on a daily basis as they go about their lives.”