The removal of the thymus gland, a procedure known as thymectomy, is likely beneficial for older patients with a particular subtype of myasthenia gravis (MG), according to a study recently published in the Journal of Neurology.
The subtype of MG, known as nonthymomatous anti-acetylcholine receptor antibody (anti-AchR Ab) positive MG, is often treated with thymectomy when it appears in younger patients, as the thymus plays a role in driving key disease processes. However, based on available research this approach isn’t usually recommended for patients older than 50.
Researchers sought to investigate if there may be a clinical basis for thymectomy in patients with late-onset MG (LOMG), defined as MG that has an age of onset above 50. Specifically, they sought to investigate if thymectomy improved clinical outcomes relative to medical therapy alone.
The research team analyzed the clinical records of patients with nonthymomatous LOMG who were seen at a medical center between 1996 and 2024. They excluded patients who had cancer involving the thymus and patients with a minimum follow-up period of less than 12 months following the procedure.
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Of the 127 patients with LOMG whose records were included, 87 underwent thymectomy and 40 received medical treatment alone, without this surgery. In the year following thymectomy, the group of patients who underwent thymectomy had a greater decrease in corticosteroid dosage and greater evidence of clinical improvement. At the last follow-up, researchers found that those who underwent thymectomy were more likely to have mild disease status or be asymptomatic than those who didn’t receive a thymectomy.
Furthermore, patients who underwent thymectomy had a higher proportion of cases in remission. The likelihood of disease remission in this group of patients remained significant even after adjusting for age, sex, severity of the disease and the administration of immunotherapy.
“Thymectomy appeared to be associated with a higher probability of achieving both complete clinical and pharmacological remission without ongoing immunosuppressive therapy in LOMG patients, compared to medical therapy alone,” the research team wrote. “These observations suggest that age alone might not necessarily preclude surgical consideration.”
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