Study finds thymectomy a "one-shot deal" for those with myasthenia gravis

Jan 28, 2019

A new study led by UB faculty says surgery to remove the thymus gland in patients with myasthenia gravis (MG), a relatively rare autoimmune disease that impacts neuromuscular function, provides long-term health and financial benefits.


Credit lhsc.on.ca

Long ago it used to kill 1 out of 3 people that had it because of respiratory failure.

Gil Wolfe, who runs the neurology program at UB and is lead author of the team that conducted the international study, said the disease today can be treated with corticosteroids such as prednisone or by undergoing a thymectomy to remove your thymus gland, which happens to be below your sternum.

“So now, it’s really a pretty well managed disease,” said Wolfe. “But there always had been questions of what kind of benefit we were getting out of the thymectomy. Because it’s a major surgical procedure. Especially if you go through the breast bone. Cause you have to split the breast bone.”

Wolfe said when you use prednisone, you also end up using other agents to reduce the side effects that come with it. Those costs can add up.

“The current state of considerations of health care costs and so forth. The move over the years away from thymectomy, because it seems to be done somewhat less now than say… 30 or 40 years ago. We need to reconsider that,” he said.

Wolfe said they’ve known for decades going back to early 1900’s the thymus gland plays a role in myasthenia gravis generation.

Wolfe said this was supported by federal tax dollars through the National Institute of Neurological Disorders and Stroke, which is a branch of the NIH. Not until that study was finalized with the results published in 2016 was it clear that thymectomy benefits patients on several levels.

“That’s why high impact journals have wanted to publish the study. Besides the fact that it was funded by NIH. And NIH, when it comes to clinical trials or other research, generally is only funding things that has significant impact,” Wolfe said.

Patients in the study who had surgery were stronger in the long-term, now even five years after the surgery.

“So thymectomy plus a standardized medical treatment at five years still is showing an accrual of benefits compared to those subjects who only got medication therapy alone,” Wolfe said.

Wolfe said there are medications used to treat autoimmune diseases whether it’s MG, rheumatoid arthritis, or lupus that cost far more over say a 6 to 12 month period than a thymectomy does.

“It keeps people out of hospitals, it reduces their medication requirements, including requirements for medications that can be rather expensive, and compared to everything else, it’s a one-shot deal,” he said. “If you do it once and you don’t have to repeat it versus medications that somebody would take on a chronic lifelong basis sometimes.”

While MG is roughly found in one out of every eight to ten thousand people, Wolfe said it’s the most common disease of neuro-muscular transmission. With better diagnosis practices and an aging population, the potentially 60,000 Americans diagnosed may be on the rise.