A study on the efficacy of surgery to remove the thymus in myasthenia gravis patients, led by researchers at the University of Alabama at Birmingham, has been named one of the top neurology stories of 2016 by the New England Journal of Medicine Journal Watch. The results of the MGTX trial were reported in NEJM in August 2016.
The study was the first randomized trial to assess whether surgery to remove the thymus, long a mainstay of treatment for MG, actually provided any benefit or improved clinical outcomes.
Gary Cutter, Ph.D., professor in the Department of Biostatistics in the UAB School of Public Health and principal investigator of the MGTX study, led the multisite, multinational and multidisciplinary study. Inmaculada Aban, Ph.D., professor in the Department of Biostatistics, served as the study’s deputy director and ran the data-coordinating center.
The study enrolled 126 patients with MG without a thymoma, or tumor. Some underwent a surgical procedure to remove the thymus, known as a thymectomy, and received a commonly used MG medication called prednisone. A second group received prednisone alone.
The surgery group had a better Quantitative Myasthenia Gravis score (6.15 vs 8.99) and a lower average requirement for alternate-day prednisone, requiring 44 mg against 60 mg for the medication-only group over the three years of follow-up.
Cutter and colleagues concluded patients treated with thymectomy were less affected by symptoms than those treated with prednisone alone, required less prednisone and other immune-suppressing medications, and had fewer hospitalizations due to flare-ups. The authors wrote that thymectomy improved clinical outcomes over a three-year period in these patients.
Inclusion in the NEJM Journal Watch list is determined through consideration of the relevance to the clinician, coverage of the various fields within neurology, recognition of landmark studies, and media publicity and public awareness.
The MGTX trial was funded by the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health.