Thymectomy has been used for the past 75 years in the treatment of myasthenia gravis, but until now, there has been is no conclusive evidence of its benefit. Joshua Sonett, MD, Chief of General Thoracic Surgery at NYP/Columbia and Director, The Price Family Center for Comprehensive Chest Care, Lung and Esophageal Center, reports on a multicenter, randomized trial comparing thymectomy plus prednisone with prednisone alone, in the August 11 issue of The New England Journal of Medicine. Dr Sonett was part of the trial leadership on the executive committee and served as Overall Study surgical PI. This research supports the use of thymectomy to improve clinical outcomes and reduce the need for immunosuppressive therapy in patients with myasthenia gravis.
Highlights:
- In patients with non thymomatous myasthenia gravis, thymectomy plus prednisone was associated with better clinical outcomes than prednisone alone
- Patients treated with thymectomy had fewer hospitalizations for exacerbations and required lower prednisone doses.
- Thymectomy improved clinical outcomes over a 3-year period in patients with nonthymomatous myasthenia gravis.
- Improvements were seen in age cohorts younger than 40 and older than 40
- Importantly, the study protocol strictly required and tested bilateral extended thymectomy
"This incredibly important study addresses a long unresolved clinical dilemma, and definitively proves the benefit of thymectomy in Myathenia Gravis,” says Dr. Sonett. “An extended or maximal thymectomy encompassing all mediastinal tissue, including the discrete thymus gland, should be considered the standard of surgical care. The study highlights the ability to answer important clinical questions with only a limited amount of patients using a rigorous prospective randomized trial with international enrollment.”