Comparison of Short-Term Post-Thymectomy Outcomes by Time-Weighted Dosages of Drug Requirements between Thymoma and Non-Thymoma Myasthenia Gravis Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population and Setting
2.2. Data Collection
- (1)
- “MGFA-PIS” outcome classifications as: complete stable remission (CSR), pharmacologic remission (PR) and minimal manifestations (MM 0–3) following standard definitions.
- (2)
- “Changes in clinical status”, for which we only studied “exacerbation”, “crisis” and “died of MG”. We did not include “better”, “unchanged” or “worse” because of their subjectivity as mentioned, and they were replaced by the TWAs of MG drug dosages of our study design. We expanded the definitions of exacerbation, crisis and died of MG for this study as follows:
- Exacerbation: post-thymectomy MG patients with CSR, PR or MM who had recently developed a clinical progression of MG symptoms significantly greater than that described in each category and had required a symptomatic drug or immune-suppressants (prednisolone or azathioprine) ≥50% of the baseline dosage before the exacerbation.
- Crisis: the condition of emerging respiratory compromise in a previously stable post-thymectomy clinical status patient, and endotracheal intubation with mechanical ventilation was indicated for respiratory support.
- Died of MG: an MG patient whose cause of death was directly related to the MG itself or MG treatment complications, or death occurred within 30 days after the thymectomy.
2.3. Statistical Analysis
2.4. Ethics Approval Statement
2.5. Data Availability Statement
3. Results
3.1. Study Participants’ Characteristics
3.2. Comparison of Time-Weighted Average (TWA) Dosages of Requirements for MG Drugs after Thymectomy between ThMG and Non-ThMG Patients
3.3. Post-Thymectomy Outcomes Assesed by MG-PIS; Frequency of Exacerbations, Crises and Death from MG
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Clinical Characteristic | ThMG Patients | Non-ThMG Patients | Total | p Value | |
---|---|---|---|---|---|
(n = 20) | (n = 65) | N = 85 | |||
Sex | Fisher’s exact test | 0.214 | |||
Male | 6 (30) | 11 (16.9) | 17 (20) | ||
Female | 14 (70) | 54 (83.1) | 68 (80) | ||
Age at the diagnosis of MG, Yrs, median (IQR) | 44 (41.8, 49.2) | 33 (21.5, 44) | 36 (25.2, 46) | Rank Sum test | 0.008 * |
MGFA classification | Fisher’s exact test | 0.253 | |||
Grade 1 | 2 (11.1) | 16 (27.6) | 18 (23.7) | ||
Grade 2a | 5 (27.8) | 9 (15.5) | 14 (18.4) | ||
Grade 2b | 9 (50) | 30 (51.7) | 39 (51.3) | ||
Grade 3a | 0 (0) | 1 (1.7) | 1 (1.3) | ||
Grade 3b | 0 (0) | 1 (1.7) | 1 (1.3) | ||
Grade 5 | 2 (11.1) | 1 (1.7) | 3 (3.9) | ||
Time from the diagnosis of MG to thymectomy, months, median (IQR) | 8.5 (2, 12) | 22 (10.2, 46.5) | 12 (7.8, 37.5) | Rank Sum test | 0.03 * |
TSH µIU/L, | 0.8 (0.5, 1.4) | 1.5 (1, 2.5) | 1.3 (0.8, 2.3) | Rank Sum test | 0.017 * |
median (IQR) | |||||
Initial dosages of drugs for treating MG | |||||
(a) Prednisolone, mg/d | 30 (16.2, 47.5) | 20 (11.2, 30) | 25 (15, 32.5) | Rank Sum test | 0.068 |
median (IQR) | |||||
(b) Pyridostigmine, mg/d, | 240 (180, 300) | 240 (180, 300) | 240 (180, 300) | Rank Sum test | 0.839 |
median (IQR) | |||||
(c) Azathioprine, mg/d, | 50 (50, 100) | 87.5 (50, 100) | 75 (50, 100) | Rank Sum test | 0.878 |
median (IQR) |
Thymoma (n = 17) | Non-Thymoma (n = 45) | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Pyr | p | A | Pyr + p | Pyr + A | p + A | all | None | Pyr | p | A | Pyr + p | Pyr + A | p + A | all | None | |
Y1 | 2 | 1 | 0 | 1 | 2 | 1 | 6 | 0 | 1 | 2 | 1 | 9 | 5 | 0 | 19 | 0 |
Y2 | 0 | 0 | 0 | 2 | 2 | 2 | 3 | 0 | 2 | 2 | 0 | 8 | 9 | 0 | 13 | 2 |
Y3 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 3 | 0 | 0 | 7 | 9 | 0 | 12 | 1 |
Y4 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 4 | 0 | 0 | 3 | 7 | 0 | 9 | 0 |
Y5 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 4 | 5 | 0 | 8 | 1 |
Drug and Time (Months) Post-Thymectomy | ThMG n= 17 Median (IQR) | Non-ThMG n = 45 Median (IQR) | p Value |
---|---|---|---|
Pyr 6 | 277.3 (228.2, 390) | 218.5 (160.9, 285) | 0.055 |
Pyr 12 | 259.3 (240, 390) | 182.3 (122.2, 242) | 0.037 * |
Pyr 18 | 240 (209.6, 285) | 190 (120, 240) | 0.18 |
Pyr 24 | 214.7 (120, 240) | 180 (173.9, 240) | 0.975 |
Pyr 30 | 240 (120, 269.4) | 180 (145.5, 238.6) | 0.739 |
Pyr 36 | 158.7 (120, 211.3) | 180 (135, 232.1) | 0.53 |
Pyr 42 | 180 (120, 180) | 180 (150, 240) | 0.38 |
Pyr 48 | 180 (165, 195) | 180 (120, 259.9) | 0.878 |
Pyr 54 | 154 (126, 210.3) | 180 (180, 311.6) | 0.464 |
Pyr 60 | 180 (150, 330) | 181.2 (180, 345) | 0.863 |
Pyr 66 | 200.7 (152.3, 249) | 330 (165, 480) | NA |
Drug and Time (Months) Post-Thymectomy | ThMG n = 17 Median (IQR) | Non-ThMG n = 45 Median (IQR) | p Value |
---|---|---|---|
P 6 | 17.9 (11, 25.2) | 13.2 (8.1, 22.7) | 0.446 |
P 12 | 9.9 (5, 30.7) | 9.8 (5, 17.2) | 0.368 |
P 18 | 5.8 (2.5, 19.4) | 5 (1.4, 13.1) | 0.43 |
P 24 | 2.5 (0, 5) | 5 (1.1, 10) | 0.259 |
P 30 | 5 (1.2, 9.2) | 5 (0, 10) | 0.946 |
P 36 | 2.7 (1.8, 4.5) | 5 (0, 9.4) | 0.842 |
P 42 | 5 (0, 5) | 5 (0, 10) | 0.826 |
P 48 | 2.5 (0, 17.5) | 5 (1.6, 14.6) | 0.647 |
P 54 | 6.8 (3.8, 12.9) | 5 (4.6, 9.5) | 0.708 |
P 60 | 7.7 (3.9, 16.6) | 5 (2.8, 10) | 0.708 |
P 66 | 10.7 (7.8, 13.5) | 0.5 (0.2, 7.8) | NA |
Drug and Time (Months) Post-Thymectomy | ThMG n = 17 Median (IQR) | Non-Th MG n = 45 Median (IQR) | p Value |
---|---|---|---|
A 6 | 50 (0, 89.7) | 50 (0, 83) | 1 |
A 12 | 50 (0, 79.8) | 56.4 (0, 100) | 0.575 |
A 18 | 50 (0, 95.1) | 50 (27.5, 100) | 0.608 |
A 24 | 32.6 (0, 50) | 50 (3.3, 102.2) | 0.092 |
A 30 | 36 (0, 55.5) | 50 (0, 114.9) | 0.384 |
A 36 | 37.5 (6.2, 64.9) | 50 (0, 125) | 0.387 |
A 42 | 25 (0, 50) | 50 (11.6, 102.3) | 0.199 |
A 48 | 25 (0, 51.5) | 98.3 (13.6, 119.2) | 0.172 |
A 54 | 41.1 (24.2, 56) | 50 (0, 135.2) | 0.535 |
A 60 | 50 (50, 82.5) | 55 (12.5, 143.8) | 0.931 |
A 66 | 38.9 (33.3, 44.4) | 103.3 (89.2, 126.7) | NA |
Exacerbation | ThMG | Non-ThMG | Total | p Value | |
---|---|---|---|---|---|
Year 1 | 10 | 40 | 50 | Fisher’s exact test | 0.671 |
No | 7 (70) | 32 (80) | 39 (78) | ||
Yes | 3 (30) | 8 (20) | 11 (22) | ||
Year 2 | 9 | 37 | 46 | Fisher’s exact test | 1 |
No | 8 (88.9) | 32 (86.5) | 40 (87) | ||
Yes | 1 (11.1) | 5 (13.5) | 6 (13) | ||
Year 3 | 7 | 26 | 33 | Fisher’s exact test | 0.145 |
No | 4 (57.1) | 22 (84.6) | 26 (78.8) | ||
Yes | 3 (42.9) | 4 (15.4) | 7 (21.2) | ||
Year 4 | 4 | 19 | 23 | Fisher’s exact test | 1 |
No | 4 (100) | 17 (89.5) | 21 (91.3) | ||
Yes | 0 (0) | 2 (10.5) | 2 (8.7) | ||
Year 5 | 4 | 15 | 19 | Fisher’s exact test | 0.178 |
No | 2 (50) | 13 (86.7) | 15 (78.9) | ||
Yes | 2 (50) | 2 (13.3) | 4 (21.1) |
Pre-Thymectomy Crisis | ThMG n = 14 | Non-ThMG n = 48 | Total | Test Stat | p Value |
---|---|---|---|---|---|
No | 9 (64.3) | 34 (70.8) | 43 (69.4) | Fisher’s exact | 0.744 |
Yes | 5 (35.7) | 14 (29.2) | 19 (30.6) | ||
Post-thymectomy crisis | |||||
No | 12 (85.7) | 44(91.7) | 56 (90.3) | Fisher’s exact | 0.610 |
Yes | 2 (14.3) | 4 (8.3) | 6 (9.7) |
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Wiboonpong, P.; Setthawatcharawanich, S.; Korathanakhun, P.; Amornpojnimman, T.; Pruphetkaew, N.; Chongphattararot, P.; Sathirapanya, C.; Sathirapanya, P. Comparison of Short-Term Post-Thymectomy Outcomes by Time-Weighted Dosages of Drug Requirements between Thymoma and Non-Thymoma Myasthenia Gravis Patients. Int. J. Environ. Res. Public Health 2023, 20, 3039. https://doi.org/10.3390/ijerph20043039
Wiboonpong P, Setthawatcharawanich S, Korathanakhun P, Amornpojnimman T, Pruphetkaew N, Chongphattararot P, Sathirapanya C, Sathirapanya P. Comparison of Short-Term Post-Thymectomy Outcomes by Time-Weighted Dosages of Drug Requirements between Thymoma and Non-Thymoma Myasthenia Gravis Patients. International Journal of Environmental Research and Public Health. 2023; 20(4):3039. https://doi.org/10.3390/ijerph20043039
Chicago/Turabian StyleWiboonpong, Phattamon, Suwanna Setthawatcharawanich, Pat Korathanakhun, Thanyalak Amornpojnimman, Nannapat Pruphetkaew, Pensri Chongphattararot, Chutarat Sathirapanya, and Pornchai Sathirapanya. 2023. "Comparison of Short-Term Post-Thymectomy Outcomes by Time-Weighted Dosages of Drug Requirements between Thymoma and Non-Thymoma Myasthenia Gravis Patients" International Journal of Environmental Research and Public Health 20, no. 4: 3039. https://doi.org/10.3390/ijerph20043039