According to a report published in The Journal of Clinical Neuroscience, advanced-onset myasthenia gravis (AOMG), which is MG that starts after age 70, has distinct clinical features compared with MG that begins between ages 50 and 69, known as late-onset MG (LOMG). Patients with AOMG experience more speech and swallowing problems and a lower prevalence of thymoma (tumors of the thymus gland); they may also receive less aggressive treatment approaches and have higher mortality rates.
“In recent decades, the incidence of [LOMG], defined as disease onset at or after the age of 50, has risen substantially, particularly among elderly populations,” the authors wrote. “Tailored management strategies are warranted for elderly patients with MG.”
The researchers looked at 982 Chinese patients with MG who were diagnosed after age 50. They divided the patients into early LOMG (ages 50-69) and AOMG (age 70 or older) and compared their symptoms, test results, treatments and outcomes over time.
They found some clear differences between the groups. Patients with AOMG were more likely to be women, to test positive for MG-related antibodies and to have speech and swallowing problems than those with LOMG. They also had lower occurrence of thymoma and fewer thymus surgeries.
Patients with AOMG received fewer immunosuppressive drugs, yet they were able to achieve reasonably stable daily functioning and symptom control. However, death from MG crisis or other health problems such as stroke were a significant risk in the 70+ group.
“Our findings underscore the need to re-evaluate current clinical approaches to AOMG, which may be shaped by age-related biases or concerns about treatment tolerance,” the authors noted.
The researchers emphasized the need for personalized treatment for AOMG, including managing comorbidities and symptoms such as speech and swallowing problems. They also suggested setting up multicenter registries of patients with AOMG to improve our understanding of the impact of MG on quality of life and outcomes in this older population.
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