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Anti-dsDNA Is Associated with Favorable Prognosis in Myasthenia Gravis: A Retrospective Study. Acta Neurol Scand 2023. [DOI: 10.1155/2023/8939083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Objectives. To investigate the presence of serum antinuclear antibody (ANA) and anti-double-stranded DNA antibody (anti-dsDNA) in patients with myasthenia gravis (MG) and analyze the clinical characteristics and prognostic factors associated with MG. Methods. We retrospectively enrolled 363 patients with MG and analyzed the clinical characteristics and follow-up data between patients positive and negative for ANA and anti-dsDNA. We defined a Myasthenia Gravis Activities of Daily Living (MG-ADL) reduction as a main prognosis predictor and used logistic regression to determine independent factors associated with prognosis. We built a nomogram to predict prognosis and evaluate the internal validity of the model. Results. Ninety-eight (27.0%) patients were positive for ANA, and 51 (14.0%) were positive for anti-dsDNA. Patients positive for ANA and anti-dsDNA antibodies tended to be female and positive for acetylcholine receptor antibody (AChR-Ab). The rate of thymoma was higher in anti-dsDNA-positive patients with MG (p-dsDNA-MG) than in patients negative for anti-dsDNA (49.0% vs. 26.0%,
), and p-dsDNA-MG was associated with reduced MG-ADL score. Regression analysis showed that except for age of onset (
,
,
), anti-dsDNA (
,
,
), ptosis (
,
,
), and eye movement disorder (
,
,
) were independent predictive factors of a favorable prognosis of MG. These predictors were used to generate a nomogram with an excellent predictive value. Conclusions. Being female and the presence of AChR-Ab were features of ANA- or anti-dsDNA-positive MG. The presence of anti-dsDNA was associated with a favorable prognosis of MG.
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Zhong H, Ruan Z, Yan C, Lv Z, Zheng X, Goh LY, Xi J, Song J, Luo L, Chu L, Tan S, Zhang C, Bu B, Da Y, Duan R, Yang H, Luo S, Chang T, Zhao C. Short-term outcome prediction for myasthenia gravis: an explainable machine learning model. Ther Adv Neurol Disord 2023; 16:17562864231154976. [PMID: 36860354 PMCID: PMC9969443 DOI: 10.1177/17562864231154976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 01/15/2023] [Indexed: 02/26/2023] Open
Abstract
Background Myasthenia gravis (MG) is an autoimmune disease characterized by muscle weakness and fatigability. The fluctuating nature of the disease course impedes the clinical management. Objective The purpose of the study was to establish and validate a machine learning (ML)-based model for predicting the short-term clinical outcome in MG patients with different antibody types. Methods We studied 890 MG patients who had regular follow-ups at 11 tertiary centers in China from 1 January 2015 to 31 July 2021 (653 patients for derivation and 237 for validation). The short-term outcome was the modified post-intervention status (PIS) at a 6-month visit. A two-step variable screening was used to determine the factors for model construction and 14 ML algorithms were used for model optimisation. Results The derivation cohort included 653 patients from Huashan hospital [age 44.24 (17.22) years, female 57.6%, generalized MG 73.5%], and the validation cohort included 237 patients from 10 independent centers [age 44.24 (17.22) years, female 55.0%, generalized MG 81.2%]. The ML model identified patients who were improved with an area under the receiver operating characteristic curve (AUC) of 0.91 [0.89-0.93], 'Unchanged' 0.89 [0.87-0.91], and 'Worse' 0.89 [0.85-0.92] in the derivation cohort, whereas identified patients who were improved with an AUC of 0.84 [0.79-0.89], 'Unchanged' 0.74 [0.67-0.82], and 'Worse' 0.79 [0.70-0.88] in the validation cohort. Both datasets presented a good calibration ability by fitting the expectation slopes. The model is finally explained by 25 simple predictors and transferred to a feasible web tool for an initial assessment. Conclusion The explainable, ML-based predictive model can aid in forecasting the short-term outcome for MG with good accuracy in clinical practice.
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Affiliation(s)
| | | | | | - Zhiguo Lv
- Department of Neurology, The Affiliated
Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Xueying Zheng
- Department of Biostatistics, School of Public
Health and Key Laboratory of Public Health Safety, Fudan University,
Shanghai, China
| | - Li-Ying Goh
- Shanghai Medical College, Fudan University,
Shanghai, China
| | - Jianying Xi
- Huashan Rare Disease Center, Department of
Neurology, Huashan Hospital, Fudan University, Shanghai, China,National Center for Neurological Disorders,
Shanghai, China
| | - Jie Song
- Huashan Rare Disease Center, Department of
Neurology, Huashan Hospital, Fudan University, Shanghai, China,National Center for Neurological Disorders,
Shanghai, China
| | - Lijun Luo
- Department of Neurology, Wuhan No.1 Hospital,
Wuhan, China
| | - Lan Chu
- Department of Neurology, The Affiliated
Hospital of Guizhou Medical University, Guiyang, China
| | - Song Tan
- Department of Neurology, Sichuan Provincial
People’s Hospital, University of Electronic Science and Technology of China,
Chengdu, China
| | - Chao Zhang
- Department of Neurology and Tianjin
Neurological Institute, Tianjin Medical University General Hospital,
Tianjin, China
| | - Bitao Bu
- Department of Neurology, Tongji Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
Wuhan, China
| | - Yuwei Da
- Department of Neurology, Xuanwu Hospital,
Capital Medical University, Beijing, China
| | - Ruisheng Duan
- Department of Neurology, The First Affiliated
Hospital of Shandong First Medical University, Jinan, China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital,
Central South University, Changsha, China
| | | | - Ting Chang
- Department of Neurology, Tangdu Hospital, The
Air Force Medical University, Xi’an 710000, China
| | - Chongbo Zhao
- Huashan Rare Disease Center, Department of
Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China,National Center for Neurological Disorders,
Shanghai, China
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Ali A, Almalki D, Kotb MA, Alenazi RS. Outcomes and characteristics of myasthenia gravis: A 10-year retrospective cross-sectional study at King Fahad Medical City. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2022; 27:237-243. [PMID: 36252965 PMCID: PMC9749576 DOI: 10.17712/nsj.2022.4.20220038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/06/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To investigate the distribution of muscle weakness in Myasthenia gravis (MG) and the therapeutic response in each category. METHODS This is a retrospective cross-sectional study included all MG patients presented to our clinic between 2010 and 2020. The demographic, clinical, serological, electrophysiological, radiological, and histopathological data of the patients were recorded. The details of the treatment administered were also documented. Muscle weakness was divided into: ocular, bulbar, and generalized. RESULTS The mean age of the 147 patients included in this study was 34.2±16.6 years. The most common presentation was ocular MG (57.1%). There was no significant association between the gender of the patients and the MG subgroups. Antibodies against AChR were reported in 95.2%, 75%, and 87% of the patients with ocular, bulbar, and generalized myasthenia, respectively. Anti-MuSK antibodies were detected in 20% of the patients with bulbar weakness. Most of the patients with ocular (91.7%) and bulbar (90%) presentation developed generalized weakness. At the end of the follow-up, 82.6%, 70.2%, and 57.5% of the patients with generalized, ocular, and bulbar presentations, respectively demonstrated well-controlled weakness. CONCLUSION The most common initial presentation was ocular weakness. Most patients with ocular and bulbar presentation developed generalized weakness during the follow up period. The most frequently reported autoantibody was against AChR. Most patients with generalized, ocular, and bulbar presentation demonstrated well-controlled weakness at the end of the follow up period.
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Affiliation(s)
- Abdulrahman Ali
- From the Department of Neurology (Ali, Alenazi), King Fahad Medical City, Riyadh, from the Department of Medicine (Almalki, Kotb), College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia, and from the Department of Neurology (Kotb), Faculty of Medicine, Minia University, Minia, Egypt
| | - Daifallah Almalki
- From the Department of Neurology (Ali, Alenazi), King Fahad Medical City, Riyadh, from the Department of Medicine (Almalki, Kotb), College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia, and from the Department of Neurology (Kotb), Faculty of Medicine, Minia University, Minia, Egypt
| | - Mamdouh A. Kotb
- From the Department of Neurology (Ali, Alenazi), King Fahad Medical City, Riyadh, from the Department of Medicine (Almalki, Kotb), College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia, and from the Department of Neurology (Kotb), Faculty of Medicine, Minia University, Minia, Egypt
| | - Reem S. Alenazi
- From the Department of Neurology (Ali, Alenazi), King Fahad Medical City, Riyadh, from the Department of Medicine (Almalki, Kotb), College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia, and from the Department of Neurology (Kotb), Faculty of Medicine, Minia University, Minia, Egypt
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Punga AR, Maddison P, Heckmann JM, Guptill JT, Evoli A. Epidemiology, diagnostics, and biomarkers of autoimmune neuromuscular junction disorders. Lancet Neurol 2022; 21:176-188. [DOI: 10.1016/s1474-4422(21)00297-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/18/2021] [Accepted: 08/25/2021] [Indexed: 12/14/2022]
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Song Z, Zhang J, Meng J, Jiang G, Yan Z, Yang Y, Chen Z, You W, Wang Z, Chen G. Different Monoclonal Antibodies in Myasthenia Gravis: A Bayesian Network Meta-Analysis. Front Pharmacol 2022; 12:790834. [PMID: 35115936 PMCID: PMC8804097 DOI: 10.3389/fphar.2021.790834] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Myasthenia gravis (MG) is a common autoimmune disease with acquired neuromuscular transmission disorders. Recently, monoclonal antibodies have been shown to successfully treat a variety of diseases. Methods: In this meta-analysis, an appropriate search strategy was used to search eligible randomized controlled trials (RCTs) on different monoclonal antibodies to treat patients with MG published up to September 2021 from the embase, PubMed, and Cochrane Library. We assessed the average difference or odds ratio between each drug and placebo and summarized them as the average and 95% confidence interval (CI), respectively. Results: In indicators of efficacy, patients receiving eculizumab (MD, −1.9; 95% CI, −3.2–0.76) had decreases in MG-ADL scores compared to placebo. In addition, only eculizumab (MD, −3.1; 95% CI, −4.7–1.5) and efgartigimod (MD, −1.4; 95% CI, −2.1–0.68) showed a significant difference from placebo in the amount of reduction in QMG scores, while neither of the other two monoclonal antibodies was statistically significant. With regard to the safety of monoclonal antibody therapy, there was no significant difference in the probability of AE in subjects treated with any of the four monoclonal antibodies compared to placebo. Conclusions: eculizumab was effective in reducing MG-ADL scores and QMG scores in myasthenia gravis. Meanwhile, eculizumab also caused fewer AE. As an emerging therapy, monoclonal antibodies are prospective in the treatment of MG. However, more researches are required to be invested in the future as the results obtained from small sample sizes are not reliable enough.
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Affiliation(s)
- Zhaoming Song
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jie Zhang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiahao Meng
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Guannan Jiang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zeya Yan
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yanbo Yang
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhouqing Chen
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wanchun You
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Wanchun You, ; Zhong Wang,
| | - Zhong Wang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Wanchun You, ; Zhong Wang,
| | - Gang Chen
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
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Birnbaum S, Bachasson D, Sharshar T, Porcher R, Hogrel JY, Portero P. Free-Living Physical Activity and Sedentary Behaviour in Autoimmune Myasthenia Gravis: A Cross-Sectional Study. J Neuromuscul Dis 2021; 8:689-697. [PMID: 33843693 DOI: 10.3233/jnd-210637] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Muscle weakness and fatigability, the prominent symptoms of autoimmune myasthenia gravis (MG), negatively impact daily function and quality of life (QoL). It is currently unclear as to what extent symptoms limit activity and whether physical activity (PA) behaviours are associated with reduced QoL. OBJECTIVES This study aimed to describe habitual PA patterns and explore relationships between PA metrics, clinical MG characteristics, and health-related QoL (HRQoL). METHODS PA data from a tri-axial trunk accelerometer worn for seven days, was collected from females with generalized, stable MG and compared to control subjects. MG-specific evaluations, the six-minute walk test and knee extension strength were assessed in individuals with MG (IwMG). Mann-Whitney tests were used to study between-group differences. Spearman rank correlation coefficient was performed to explore relationships between variables. RESULTS Thirty-three IwMG (mean (SD) age 45 (11) years) and 66 control subjects were included. IwMG perform less vigorous-intensity PA than control subjects (p = 0.001), spend more time sedentary (p = 0.02) and engage in less and shorter durations of moderate-vigorous-intensity PA (MVPA). For IwMG, habitual PA correlated positively with 6 min walking distance (rho = 0.387, p = 0.029) and negatively with body mass index (rho = -0.407, p = 0.019). We did not find any association between PA or sedentary behaviour and; HRQoL, symptom severity nor lower limb strength. CONCLUSIONS Individuals with stable MG perform less PA, at lower intensities, and are more inactive than control individuals. Further research is warranted to understand factors influencing PA patterns in MG and whether interventions could be successful in increasing PA quantity and intensity in IwMG.
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Affiliation(s)
- Simone Birnbaum
- Neuromuscular Physiology and Evaluation Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France.,Bioingénierie, Tissus et Neuroplasticité, EA Université Paris-Est Créteil, Créteil, France.,Unité de Recherche Clinique Paris Île-de-France Ouest (URC PIFO), Raymond Poincaré Hospital, AP-HP, Garches, France
| | - Damien Bachasson
- Neuromuscular Physiology and Evaluation Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Tarek Sharshar
- Intensive Care Unit, Raymond Poincaré Hospital, AP-HP, Garches, France.,Paris-Descartes University, France.,Experimental Neuropathology, Institut Pasteur, Paris, France
| | - Raphaël Porcher
- Université de Paris, CRESS, INSERM, INRA, Paris, France.,Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel-Dieu, Paris, France
| | - Jean-Yves Hogrel
- Neuromuscular Physiology and Evaluation Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Pierre Portero
- Bioingénierie, Tissus et Neuroplasticité, EA Université Paris-Est Créteil, Créteil, France
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Thomsen JLS, Vinge L, Harbo T, Andersen H. Gender differences in clinical outcomes in myasthenia gravis: A prospective cohort study. Muscle Nerve 2021; 64:538-544. [PMID: 34036597 DOI: 10.1002/mus.27331] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION/AIMS It is uncertain whether clinical outcomes differ between male and female patients with myasthenia gravis (MG) while receiving standard clinical care. METHODS In a prospective cohort study of 107 patients with MG receiving standard of care from 2012 to 2019, the Quantitative MG (QMG), the MG Composite (MGC), the MG Activities of Daily Living (MG-ADL), and the MG Quality of Life 15-Items (QOL15) were determined. Clinical outcomes were analyzed in relation to gender. RESULTS Mean follow-up time was 4.8 (±0.4) y, and 70 patients completed all follow-up assessments. Patients improved on all clinical scores: QMG -1.8 (P < .001), MGC -1.5 (P < .001), MG-ADL -1.3 (P < .001), and QOL15 -3.0 (P < .001). Females improved less than males on the QMG (P = .01), MGC (P < .001), MG-ADL (P = .006), and QOL15 (P < .001) independent of potential confounders. Males had moderate to strong correlations between changes in all clinical scales (r range 0.52 to 0.73), whereas females had weak correlations between changes in the QMG and MG-ADL (r = 0.13), the QMG and QOL15 (r = 0.27), the MGC and MG-ADL (r = 0.21), the MGC and QOL15 (r = 0.00), and the MG-ADL and QOL15 (r = 0.31). DISCUSSION Females improved less compared to males on objective and patient-reported outcomes. Moreover, females improved more on objective measures than on patient-reported outcomes. These gender differences should receive attention in clinical care and in the design of future trials.
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Affiliation(s)
- Jan L S Thomsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | - Lotte Vinge
- Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Huan X, Luo S, Zhong H, Zheng X, Song J, Zhou L, Lu J, Wang Y, Xu Y, Xi J, Zou Z, Chen S, Zhao C. In-depth peripheral CD4 + T profile correlates with myasthenic crisis. Ann Clin Transl Neurol 2021; 8:749-762. [PMID: 33616296 PMCID: PMC8045923 DOI: 10.1002/acn3.51312] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/31/2020] [Accepted: 01/20/2021] [Indexed: 12/12/2022] Open
Abstract
Objective Myasthenia gravis (MG) is an autoimmune disease caused by autoantibodies against neuromuscular junctions. Myasthenic crisis (MC) represents the most severe state of MG with high in‐hospital mortality. We aimed to identify immune signatures using in‐depth profiling in MC, and to assess the correlations between immune biomarkers with clinical severity longitudinally. Methods We studied 181 participants including 57 healthy controls, 96 patients with MG who never experienced crisis and 28 MC patients from December 2018 through June 2020. Follow‐up visits occurred prospectively from crisis to 6 months off‐mechanical ventilation. The frequencies of 20 CD4+ T subpopulations and 18 serum cytokines were associated with clinical scores using correlations and principal component analysis. Results Patients in crisis exhibited a proinflammatory CD4+T response with elevated Th1 (P = 0.026), and Th17 cells (P = 0.032); decreased T follicular helper 2 (Tfh2) cells (P < 0.001), Tnaive in Tfh cells (P < 0.001), ICOS−Tfh cells (P = 0.017), and T central memory in Tfh (P = 0.022) compared with controls, and increased frequencies of Tregs (P = 0.026) and Tfh17 (P = 0.045) compared with non‐crisis MG. Cytokine cascade was identified in crisis including the ones associated with Th1 (IL‐1β/2/12p70/18/27/IFN‐γ/TNF‐α), Th2 (IL‐4/5/13), Th17 (IL‐6/17A/21/22/23/GM‐CSF), Th9 (IL‐9), and Treg (IL‐10). Longitudinally, seven immune biomarkers including Tregs, IL‐2/4/17A/IFN‐γ/TNF‐α/GM‐CSF had significant correlations with MG‐activities of daily living score. Interpretation Vigorous inflammatory CD4+ T signatures were identified in MC and are associated with clinical severity. Future research is needed to explore its potential candidacy for therapeutic intervention and predicting impending crisis.
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Affiliation(s)
- Xiao Huan
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Sushan Luo
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Huahua Zhong
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Xueying Zheng
- Department of Biostatistics, School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Jie Song
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Lei Zhou
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Jun Lu
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Ying Wang
- Department of Pharmacy, Huashan Hospital Fudan University, Shanghai, China
| | - Yafang Xu
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Jianying Xi
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Zhangyu Zou
- Department of Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, China
| | - Sheng Chen
- Department of Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, China
| | - Chongbo Zhao
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
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Putko BN, Beecher G, Siddiqi ZA. Pharmacodynamic Properties of Subcutaneous Immunoglobulin in Myasthenia Gravis: Sub-analyses From an Open-Label Trial. Front Neurol 2020; 11:921. [PMID: 32982936 PMCID: PMC7477386 DOI: 10.3389/fneur.2020.00921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/17/2020] [Indexed: 12/12/2022] Open
Abstract
Background: We previously reported an open-label prospective trial of subcutaneous immunoglobulin (SCIg) in mild to moderate exacerbations of myasthenia gravis (MG). The effective dose of SCIg in MG and whether measured immunoglobulin G (IgG) levels correlated with measures of disease burden were not reported. Objectives: To understand the relationship between SCIg dosing and serum IgG levels on measures of disease burden: quantitative MG (QMG), MG activities of daily living (MG-ADL), MG composite (MGC), and manual muscle testing (MMT) scores. Methods: We performed post-hoc analyses of variance to assess change in oculobulbar and generalized sub-scores. We assessed the improvement in QMG, MG-ADL, MGC, or MMT over intervals from baseline to week 2, weeks 2–4, and week 4 to end of study. Improvement was either greater than (coded 1) or was equal to or less than (coded 0) the previous 2 weeks. Binaries were assessed in binary logistic regression as a function of SCIg dose over the two-week interval as the independent variable. We also performed linear regression analyses with change in the clinical scores as the dependent variable and change in IgG level over the entire study period and over the interval from weeks 2 to 4, during which change in IgG level was maximal, as the independent variables. Results: Subanalysis of QMG and MG-ADL scores demonstrated significant reductions in the oculobulbar and the generalized portions of both measures. Binary logistic regression analyses did not find any statistically significant correlations between the odds of improvement and weight-adjusted dose of SCIg over 2-week intervals. There were no significant relationships between changes in scores and IgG level over the entire study period or over the interval from weeks 2 to 4. Conclusions: Although SCIg dose varied over the study period, the odds of improvement were not significantly correlated with this, which suggests that the current dose of 2 g/kg for SCIg should be compared to different, possibly lower, dosing regimens head-to-head. The change in clinical scores was not significantly associated with IgG levels suggesting a complex relationship. SCIg may be effective for both ocular and generalized presentations of MG.
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Affiliation(s)
- Brendan N Putko
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Grayson Beecher
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Zaeem A Siddiqi
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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de Meel RHP, Barnett C, Bril V, Tannemaat MR, Verschuuren JJGM. Myasthenia Gravis Impairment Index: Sensitivity for Change in Generalized Muscle Weakness. J Neuromuscul Dis 2020; 7:297-300. [PMID: 32250313 PMCID: PMC7369124 DOI: 10.3233/jnd-200484] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The recently developed Myasthenia Gravis Impairment Index (MGII) is a promising measure as it has less floor effects and a higher relative efficiency in its responsiveness to treatment effect compared to other MG measures. This study aimed at validating the MGII in a Dutch cohort of MG patients and analyzing the sensitivity of MGII compared to MG-ADL for changes in generalized weakness. METHODS We analyzed (generalized items of; -gen) MGII, quantitative myasthenia gravis (QMG), Myasthenia Gravis Activities of Daily Living (MG-ADL), EQ-5D visual analog, Myasthenia Gravis Composite (MGC) and ACTIVLIM (an ADL questionnaire focusing on generalized weakness) scores in a prospective cohort of 99 MG patients. We investigated correlations between MGII and other outcome measures. We used a generalized linear model to assess whether MGIIgen had an additional sensitivity on top of MG-ADLgen for changes (Δ) in QMGgen in individual patients. RESULTS MGII had a lower floor effect (4%) compared to QMG (6%), MG-ADL (11%) and MGC (16%). MGII correlated well with QMG (r = 0.68), MG-ADL (r = 0.83) and MGC (r = 0.74). As expected, the correlations with EQ visual analog and ACTIVLIM were lower (r = - 0.57 and - 0.48). ΔMGIIgen had an additional value on top of ΔMG-ADLgen in the prediction of ΔQMGgen (B = 0.54, p = 0.01). DISCUSSION The MGII score was cross-culturally validated in a Dutch cohort of MG patients. MGII had a higher sensitivity for generalized weakness than MG-ADL.
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Affiliation(s)
- Robert H P de Meel
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Carolina Barnett
- Department of Medicine, Division of Neurology, University Health Network and University of Toronto, Toronto, Canada
| | - Vera Bril
- Department of Medicine, Division of Neurology, University Health Network and University of Toronto, Toronto, Canada.,Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Martijn R Tannemaat
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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