The clinical outcome in AChR-positive generalized myasthenia gravis: A retrospective observational study
Background: Myasthenia gravis (MG) is an autoimmune disease affecting the neuromuscular junction, and in over 80% of cases, antibodies are identified against the nicotinic type of acetylcholine receptor (AChR) on the muscle endplate. Despite the availability of various treatment options, patients wi...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2023-01-01
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| Series: | Annals of Indian Academy of Neurology |
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| Online Access: | http://www.annalsofian.org/article.asp?issn=0972-2327;year=2023;volume=26;issue=4;spage=395;epage=400;aulast=Ojha |
| _version_ | 1797649502519164928 |
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| author | Pawan T Ojha Abhijeet M Gaikwad Rakesh Singh Kamlesh Jagiasi Shashank Nagendra |
| author_facet | Pawan T Ojha Abhijeet M Gaikwad Rakesh Singh Kamlesh Jagiasi Shashank Nagendra |
| author_sort | Pawan T Ojha |
| collection | DOAJ |
| description | Background: Myasthenia gravis (MG) is an autoimmune disease affecting the neuromuscular junction, and in over 80% of cases, antibodies are identified against the nicotinic type of acetylcholine receptor (AChR) on the muscle endplate. Despite the availability of various treatment options, patients with MG experience relapses and remission during the course of the disease. Aims and Objective: To understand the clinical profile, predictors of outcomes in acetyl choline receptor (AChR) antibody positive generalized MG. Methods: This is a retrospective, single-centre, observational study of 108 patients with AChR positive generalized MG. We collected data on clinical and demographical profiles, treatments received, and treatment responses from those who fulfilled inclusion criteria over a mean follow up period of 33.75 ±7.30 months. Clinical outcomes were studied in terms of the type of remission and crisis or disease exacerbations patients had, considering different variables and treatment received. Results: We found the commonest initial symptoms were ocular or oculo-bulbar, which progressed to generalized MG in the first year of disease onset. 36 (33.3%) patients experienced a crisis requiring mechanical ventilation within a mean period of 9.4 ±4.77 months from the disease onset. Multivariate regression analysis showed late-onset MG (age of onset between 50-70 years) and treatment with rituximab were better correlated with remission, (odd ratio of 4.7; 95 % CI ,1.12 -12.6; P value < 0.05 and odd ratio of 4.56; 95 % CI ,1.2 -10.04; P value < 0.05) respectively. While treatment with Mycofenolate Mofetile (MMF) was associated with a higher number of relapses (odd ratio of 1.8; 95 % CI ,0.08 -0.96; P value < 0.05). Treatment with Rituximab showed a higher rate of remission as compared to treatment refractory (TR) on conventional immunosuppressant therapy (IST). Out of 35(32 %) thymoma patients, 21 patients underwent thymectomy and these patients showed significantly greater rate of remission as compared both thymoma patients who denied thymectomy as a treatment option (N = 10 ;55.60 % vs N = 4; 23.50%). Conclusion: In this study of AChR antibody positive generalized MG patients, we found that nearly one-third of them experienced myasthenic crisis despite receiving the best medical care. Rituximab appeared to be effective in the treatment of refractory MG and those who failed thymectomy. Thymectomy was associated with better outcomes in patients, both with or without a thymoma. |
| first_indexed | 2024-03-11T15:48:02Z |
| format | Article |
| id | doaj.art-68e8353f2c174bdab94c2cd2cf19cd4a |
| institution | Directory Open Access Journal |
| issn | 0972-2327 1998-3549 |
| language | English |
| last_indexed | 2024-03-11T15:48:02Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Annals of Indian Academy of Neurology |
| spelling | doaj.art-68e8353f2c174bdab94c2cd2cf19cd4a2023-10-26T05:44:41ZengWolters Kluwer Medknow PublicationsAnnals of Indian Academy of Neurology0972-23271998-35492023-01-0126439540010.4103/aian.aian_186_23The clinical outcome in AChR-positive generalized myasthenia gravis: A retrospective observational studyPawan T OjhaAbhijeet M GaikwadRakesh SinghKamlesh JagiasiShashank NagendraBackground: Myasthenia gravis (MG) is an autoimmune disease affecting the neuromuscular junction, and in over 80% of cases, antibodies are identified against the nicotinic type of acetylcholine receptor (AChR) on the muscle endplate. Despite the availability of various treatment options, patients with MG experience relapses and remission during the course of the disease. Aims and Objective: To understand the clinical profile, predictors of outcomes in acetyl choline receptor (AChR) antibody positive generalized MG. Methods: This is a retrospective, single-centre, observational study of 108 patients with AChR positive generalized MG. We collected data on clinical and demographical profiles, treatments received, and treatment responses from those who fulfilled inclusion criteria over a mean follow up period of 33.75 ±7.30 months. Clinical outcomes were studied in terms of the type of remission and crisis or disease exacerbations patients had, considering different variables and treatment received. Results: We found the commonest initial symptoms were ocular or oculo-bulbar, which progressed to generalized MG in the first year of disease onset. 36 (33.3%) patients experienced a crisis requiring mechanical ventilation within a mean period of 9.4 ±4.77 months from the disease onset. Multivariate regression analysis showed late-onset MG (age of onset between 50-70 years) and treatment with rituximab were better correlated with remission, (odd ratio of 4.7; 95 % CI ,1.12 -12.6; P value < 0.05 and odd ratio of 4.56; 95 % CI ,1.2 -10.04; P value < 0.05) respectively. While treatment with Mycofenolate Mofetile (MMF) was associated with a higher number of relapses (odd ratio of 1.8; 95 % CI ,0.08 -0.96; P value < 0.05). Treatment with Rituximab showed a higher rate of remission as compared to treatment refractory (TR) on conventional immunosuppressant therapy (IST). Out of 35(32 %) thymoma patients, 21 patients underwent thymectomy and these patients showed significantly greater rate of remission as compared both thymoma patients who denied thymectomy as a treatment option (N = 10 ;55.60 % vs N = 4; 23.50%). Conclusion: In this study of AChR antibody positive generalized MG patients, we found that nearly one-third of them experienced myasthenic crisis despite receiving the best medical care. Rituximab appeared to be effective in the treatment of refractory MG and those who failed thymectomy. Thymectomy was associated with better outcomes in patients, both with or without a thymoma.http://www.annalsofian.org/article.asp?issn=0972-2327;year=2023;volume=26;issue=4;spage=395;epage=400;aulast=Ojhaachr positivemyasthenia gravis (mg)rituximabtreatment refractory |
| spellingShingle | Pawan T Ojha Abhijeet M Gaikwad Rakesh Singh Kamlesh Jagiasi Shashank Nagendra The clinical outcome in AChR-positive generalized myasthenia gravis: A retrospective observational study Annals of Indian Academy of Neurology achr positive myasthenia gravis (mg) rituximab treatment refractory |
| title | The clinical outcome in AChR-positive generalized myasthenia gravis: A retrospective observational study |
| title_full | The clinical outcome in AChR-positive generalized myasthenia gravis: A retrospective observational study |
| title_fullStr | The clinical outcome in AChR-positive generalized myasthenia gravis: A retrospective observational study |
| title_full_unstemmed | The clinical outcome in AChR-positive generalized myasthenia gravis: A retrospective observational study |
| title_short | The clinical outcome in AChR-positive generalized myasthenia gravis: A retrospective observational study |
| title_sort | clinical outcome in achr positive generalized myasthenia gravis a retrospective observational study |
| topic | achr positive myasthenia gravis (mg) rituximab treatment refractory |
| url | http://www.annalsofian.org/article.asp?issn=0972-2327;year=2023;volume=26;issue=4;spage=395;epage=400;aulast=Ojha |
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