Study: Surgery is best treatment for myasthenia gravis

Surgically removing the thymus gland from patients with the rare autoimmune disease myasthenia gravis provides significant benefits for patients who don’t have a chest tumor, according to a study published in the New England Journal of Medicine.

The study’s lead author was Gil Wolfe, MD, chairman of the University of Buffalo’s Jacobs School of Medicine. It involved 126 participants who were randomized to undergo surgery, along with receiving prednisone therapy after their operation, or to receive the therapy alone.

Wolfe and his co-authors found patients who underwent a thymectomy were less affected by symptoms, required less prednisone during the three years after the surgery and had a 75 percent reduction in hospitalizations.

“These findings solidly confirm the early use of thymectomy in managing myasthenia gravis,” Wolfe wrote. “These findings tell patients they can be even more assured that thymectomy is a positive step to take in the management of their condition.”

Wolfe noted thymectomy has been used for myasthenia gravis patients since 1940, but with little clinical evidence to back up the practice. The study had been partially funded by the National Institutes of Health in order to provide answers for “this 50-year-old question.”

“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. “We hope it becomes a model for rigorously testing other treatment options.”

The NIH said the surgical option doesn’t come cheap, with the Agency for Healthcare Quality and Research estimating hospitals charged an average of $86,000 per extended transternal thymectomies, not including doctors’ fees, in 2013.