Randomized Controlled Trial

. 2020 Aug 11;95(6):e755-e766.

doi: 10.1212/WNL.0000000000010031. Epub 2020 Jul 1.

Minimal manifestation status and prednisone withdrawal in the MGTX trial

Ikjae Lee¹, Hui-Chien Kuo², Inmaculada B Aban², Gary R Cutter², Tarrant McPherson², Henry J Kaminski², Jon Sussman², Philipp Ströbel², Joel Oger², Gabriel Cea², Jeannine M Heckmann², Amelia Evoli², Wilfred Nix², Emma Ciafaloni², Giovanni Antonini², Rawiphan Witoonpanich², John O King², Said R Beydoun², Colin H Chalk², Alexandru C Barboi², Anthony A Amato², Aziz I Shaibani², Bashar Katirji², Bryan R F Lecky², Camilla Buckley², Angela Vincent², Elza Dias-Tosta², Hiroaki Yoshikawa², Marcia Waddington-Cruz², Michael T Pulley², Michael H Rivner², Anna Kostera-Pruszczyk², Robert M Pascuzzi², Carlayne E Jackson², Jan J G Verschuuren², Janice M Massey², John T Kissel², Lineu C Werneck², Michael Benatar², Richard J Barohn², Rup Tandan², Tahseen Mozaffar², Robin Conwit², Greg Minisman², Joshua R Sonett², Gil I Wolfe²; MGTX study group

Collaborators, Affiliations

Collaborators

MGTX study group:
Claudio Mazia, Saluto Valeria, Rosenberg Moises, Alvarez Valeria, Rey Lisa, Butzkueven Helmut, Goldblatt John, Carey John, Pollard John, Reddel Stephen, Handel Nicholas, McCaughan Brian, Pallot Linda, Novis Ricardo, Boasquevisque Carlos, Morato-Fernandez Rubens, Ximenes Manoel, Scola Rosana, Soltoski Paulo, Moore Fraser, Mulder David, Wadup Lisa, Mezei Michele, Evans Kenneth, Jiwa Theresa, Schaffar Anne, White Chris, Toth Cory, Gelfand Gary, Wood Susan, Pringle Elizabeth, Zwicker Jocelyn, Maziak Donna, Shamji Farid, Sundaresan Sudhir, Seely Andrew, Verdugo Renato, Aguayo Alberto, Jander Sebastian, Zickler Philipp, Klein Michael, Marx Alexander, Weis Cleo-Aron, Melms Arthur, Bischof Felix, Aebert Hermann, Ziemer Gerhard, Thümler Björn, Wilhem-Schwenkmezger Thomas, Mayer Eckhard, Schalke Berthold, Pöschel Peter, Hieber Gisela, Wiebe Karsten, Clemenzi Alessandro, Ceschin Vanessa, Rendina Erino, Venuta Federico, Morino Stefania, Bucci Elisabetta, Durelli Luca, Tavella Alessia, Clerico Marinella, Contessa Giulia, Borasio Piero, Servidei Serenella, Granone Pierluigi, Mantegazza Renato, Berta Emilia, Novellino Lorenzo, Spinelli Luisa, Motomura Masakatsu, Matsuo Hidenori, Nagayasu Takeshi, Takamori Masaharu, Oda Makoto, Matsumoto Isao, Furukawa Yutaka, Noto Daisuke, Motozaki Yuko, Iwasa Kazuo, Yanase Daisuke, Garcia Ramos Guillermo, Cacho Bernardo, de la Garza Lorenzo, Lipowska Marta, Kwiecinski Hubert, Potulska-Chromik Anna, Orlowski Tadeusz, Silva Ana, Feijo Marta, Freitas António, Frost Andrew, Lee Pan Edward, Tucker Lawrence, Rossouw Johan, Drummond Fiona, Illa Isabel, Diaz Jorge, Leon Carlos, Yeh Jiann-Horng, Chiu Hou-Chang, Hsieh Yei-San, Tunlayadechanont Supoch, Attanavanich Sukasom, Straathof Chiara, Titulaer Maarten, Versteegh Michel, Pels Arda, Krum Yvonne, Leite M. Isabel, Hilton-Jones David, Ratnatunga Chandi, Newsom-Davis John, Farrugia Maria Elena, Petty Richard, Overell James, Kirk Alan, Gibson Andrew, McDermott Chris, Hopkinson David, Dot Marshall David Watling, Deborah Davies Sam Saminaden, Siva Sathasivam Charlotte Dougan, Page Richard, Jon Sussman, Ealing John, Krysiak Peter, Salajegheh Mohammad, Jaklitsch Michael, Roe Kristen, Ashizawa Tetsuo, Smith Robert Glenn, Zwischenberg Joseph, Stanton Penny, Jaradeh Safwan, Tisol William, Gasparri Mario, Haasler George, Yellick Mary, Dennis Cedric, Pasnoor Mamatha, Dimachkie Mazen, McVey April, Gronseth Gary, Dick Arthur, Kramer Jeffrey, Currence Melissa, Herbelin Laura, Belsh Jerry, Li Geoge, Langenfeld John, Mertz Mary Ann, Harrison Taylor, Force Seth, Usher Sharon, Lin Frank, DeMeester Steve, Akhter Salem, Malekniazi Ali, Avenido Gina, Crum Brian, Milone Margherita, Cassivi Stephen, Fisher Janet, Heatwole Chad, Watson Thomas, Hilbert James, Smirnow Alexis, Distad B. Jane, Weiss Michael, Wood Douglas, Haug Joanna, Ernstoff Raina, Cao Jingyang, Chmielewski Gary, Welsh Robert, Duris Robin, Gutmann Laurie, Pawar Gauri, Graeber Geoffrey Marc, Altemus Patricia, Nance Christopher, Gutmann Ludwig, Grogan Patrick, Calhoon John, Kittrell Pamela, Myers Deborah, Hayat Ghazala, Naunheim Keith, Eller Susan, Holzemer Eve, Alshekhlee Amer, Robke Jason, Karlinchak Brenda, Katz Jonathan, Miller Robert, Roan Ralph, Forshew Dallas, Elsheikh Bakri, Ross Patrick, Chelnick Sharon, Lewis Richard, Acsadi Agnes, Baciewicz Frank, Masse Stacey, Juel Vern, Onaitis Mark, Lowe James, Lipscomb Bernadette, Thai Gaby, Milliken Jeffrey, Martin Veronica, Karayan Ronnie, Muley Suraj, Parry Gareth, Shumway Sara, Oh Shin, Claussen Gwen, Lu Liang, Cerfolio Robert, Young Angela, Morgan Marla, Kincaid John, Kesler Kenneth, Guingrich Sandy, Michaels Angi, Phillips Lawrence, Burns Ted, Jones David, Fischer Cindy, Berger Alan, D’Agostino Harry, Smith Lisa, Pruitt Jerry, Landolfo Kevin, Hillman Demetric, Sermas Angelo, Ruel Ross, Ismail Farah, Sivak Mark, Goldstein Martin, Camunas Jorge, Bratton Joan, Panitch Hill, Leavitt Bruce, Jones Marilee, Muppidi Srikanth, Vernino Steven, Nations Sharon, Meyer Dan, Gorham Nina

Affiliations

¹ From the Departments of Neurology (I.L.) and Biostatistics (H.-C.K., I.B.A., G.R.C., T.M., G.M.), University of Alabama at Birmingham; Department of Neurology (H.J.K.), George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Neurology (J.S.), Greater Manchester Neuroscience Center, Salford, Greater Manchester, UK; Institute of Pathology (P.S.), University Medical Center Göttingen; Division of Neurology (J.O.), University of British Columbia, Vancouver, Canada; Department of Neurology (G.C.), University of Chile, Santiago; Division of Neurology (J.M.H.), Department of Medicine, University of Cape Town, South Africa; Department of Neurology (A.E.), Catholic University, Rome, Italy; Department of Neurology (W.N.), Johannes Gutenberg University, Mainz, Germany; Department of Neurology (E.C.), University of Rochester Medical Center, NY; Department of Neurosciences (G.A.), Mental Health and Sensory Organs, Sapienza University of Rome, Italy; Division of Neurology (R.W.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (J.O.K.), Royal Melbourne Hospital, Victoria, Australia; Department of Neurology (S.R.B.), University of Southern California, Los Angeles; Department of Neurology (C.H.C.), McGill University, Montreal, Canada; Department of Neurology (A.C.B.), Medical College of Wisconsin, Milwaukee; Department of Neurology (A.A.A.), Harvard Medical School, Boston, MA; Nerve and Muscle Center of Texas (A.I.S.), Houston; Department of Neurology (B.K.), Case Western Reserve University, Cleveland, OH; Walton Centre for Neurology and Neurosurgery (B.R.F.L.), Liverpool; Nuffield Department of Clinical Neurosciences (C.B., A.V.), Oxford University, UK; Unit of Neurology (E.D.-T.), University of Brasilia, Brazil; Department of Neurology (H.Y.), Kanazawa University, Japan; Department of Neurology (M.W.-C.), Federal University, Rio de Janeiro, Brazil; Department of Neurology (M.T.P.), University of Florida, Jacksonville; Department of Neurology (M.H.R.), Augusta University, GA; Department of Neurology (A.K.-P.), Medical University of Warsaw, Poland; Department of Neurology (R.M.P.), Indiana School of Medicine, Indianapolis; Department of Neurology (C.E.J.), University of Texas Health Science Center, San Antonio; Department of Neurology (J.J.G.V.), Leiden University Medical Center, the Netherlands; Department of Neurology (J.M.M.), Duke University Medical Center, Durham, NC; Department of Neurology (J.T.K.), Ohio State University Wexner Medical Center, Columbus; Department of Neurology (L.C.W.), Universidade Federal do Parana, Curitiba, Brazil; Department of Neurology (M.B.), University of Miami, FL; Department of Neurology (R.J.B.), University of Kansas Medical Center, Kansas City; Department of Neurological Sciences (R.T.), University of Vermont College of Medicine, Burlington; Department of Neurology (T.M.), University of California Irvine Medical Center, Orange; Division of Extramural Research (R.C.), NIH, National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of General Thoracic Surgery (J.R.S.), Columbia University Medical Center, New York; and Department of Neurology (G.I.W.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, NY. leeij15@gmail.com.
² From the Departments of Neurology (I.L.) and Biostatistics (H.-C.K., I.B.A., G.R.C., T.M., G.M.), University of Alabama at Birmingham; Department of Neurology (H.J.K.), George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Neurology (J.S.), Greater Manchester Neuroscience Center, Salford, Greater Manchester, UK; Institute of Pathology (P.S.), University Medical Center Göttingen; Division of Neurology (J.O.), University of British Columbia, Vancouver, Canada; Department of Neurology (G.C.), University of Chile, Santiago; Division of Neurology (J.M.H.), Department of Medicine, University of Cape Town, South Africa; Department of Neurology (A.E.), Catholic University, Rome, Italy; Department of Neurology (W.N.), Johannes Gutenberg University, Mainz, Germany; Department of Neurology (E.C.), University of Rochester Medical Center, NY; Department of Neurosciences (G.A.), Mental Health and Sensory Organs, Sapienza University of Rome, Italy; Division of Neurology (R.W.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (J.O.K.), Royal Melbourne Hospital, Victoria, Australia; Department of Neurology (S.R.B.), University of Southern California, Los Angeles; Department of Neurology (C.H.C.), McGill University, Montreal, Canada; Department of Neurology (A.C.B.), Medical College of Wisconsin, Milwaukee; Department of Neurology (A.A.A.), Harvard Medical School, Boston, MA; Nerve and Muscle Center of Texas (A.I.S.), Houston; Department of Neurology (B.K.), Case Western Reserve University, Cleveland, OH; Walton Centre for Neurology and Neurosurgery (B.R.F.L.), Liverpool; Nuffield Department of Clinical Neurosciences (C.B., A.V.), Oxford University, UK; Unit of Neurology (E.D.-T.), University of Brasilia, Brazil; Department of Neurology (H.Y.), Kanazawa University, Japan; Department of Neurology (M.W.-C.), Federal University, Rio de Janeiro, Brazil; Department of Neurology (M.T.P.), University of Florida, Jacksonville; Department of Neurology (M.H.R.), Augusta University, GA; Department of Neurology (A.K.-P.), Medical University of Warsaw, Poland; Department of Neurology (R.M.P.), Indiana School of Medicine, Indianapolis; Department of Neurology (C.E.J.), University of Texas Health Science Center, San Antonio; Department of Neurology (J.J.G.V.), Leiden University Medical Center, the Netherlands; Department of Neurology (J.M.M.), Duke University Medical Center, Durham, NC; Department of Neurology (J.T.K.), Ohio State University Wexner Medical Center, Columbus; Department of Neurology (L.C.W.), Universidade Federal do Parana, Curitiba, Brazil; Department of Neurology (M.B.), University of Miami, FL; Department of Neurology (R.J.B.), University of Kansas Medical Center, Kansas City; Department of Neurological Sciences (R.T.), University of Vermont College of Medicine, Burlington; Department of Neurology (T.M.), University of California Irvine Medical Center, Orange; Division of Extramural Research (R.C.), NIH, National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of General Thoracic Surgery (J.R.S.), Columbia University Medical Center, New York; and Department of Neurology (G.I.W.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, NY.

PMID: 32611638
PMCID: PMC7455358
DOI: 10.1212/WNL.0000000000010031

Randomized Controlled Trial

Minimal manifestation status and prednisone withdrawal in the MGTX trial

Ikjae Lee et al. Neurology. 2020.

. 2020 Aug 11;95(6):e755-e766.

doi: 10.1212/WNL.0000000000010031. Epub 2020 Jul 1.

Authors

Collaborators

MGTX study group:
Claudio Mazia, Saluto Valeria, Rosenberg Moises, Alvarez Valeria, Rey Lisa, Butzkueven Helmut, Goldblatt John, Carey John, Pollard John, Reddel Stephen, Handel Nicholas, McCaughan Brian, Pallot Linda, Novis Ricardo, Boasquevisque Carlos, Morato-Fernandez Rubens, Ximenes Manoel, Scola Rosana, Soltoski Paulo, Moore Fraser, Mulder David, Wadup Lisa, Mezei Michele, Evans Kenneth, Jiwa Theresa, Schaffar Anne, White Chris, Toth Cory, Gelfand Gary, Wood Susan, Pringle Elizabeth, Zwicker Jocelyn, Maziak Donna, Shamji Farid, Sundaresan Sudhir, Seely Andrew, Verdugo Renato, Aguayo Alberto, Jander Sebastian, Zickler Philipp, Klein Michael, Marx Alexander, Weis Cleo-Aron, Melms Arthur, Bischof Felix, Aebert Hermann, Ziemer Gerhard, Thümler Björn, Wilhem-Schwenkmezger Thomas, Mayer Eckhard, Schalke Berthold, Pöschel Peter, Hieber Gisela, Wiebe Karsten, Clemenzi Alessandro, Ceschin Vanessa, Rendina Erino, Venuta Federico, Morino Stefania, Bucci Elisabetta, Durelli Luca, Tavella Alessia, Clerico Marinella, Contessa Giulia, Borasio Piero, Servidei Serenella, Granone Pierluigi, Mantegazza Renato, Berta Emilia, Novellino Lorenzo, Spinelli Luisa, Motomura Masakatsu, Matsuo Hidenori, Nagayasu Takeshi, Takamori Masaharu, Oda Makoto, Matsumoto Isao, Furukawa Yutaka, Noto Daisuke, Motozaki Yuko, Iwasa Kazuo, Yanase Daisuke, Garcia Ramos Guillermo, Cacho Bernardo, de la Garza Lorenzo, Lipowska Marta, Kwiecinski Hubert, Potulska-Chromik Anna, Orlowski Tadeusz, Silva Ana, Feijo Marta, Freitas António, Frost Andrew, Lee Pan Edward, Tucker Lawrence, Rossouw Johan, Drummond Fiona, Illa Isabel, Diaz Jorge, Leon Carlos, Yeh Jiann-Horng, Chiu Hou-Chang, Hsieh Yei-San, Tunlayadechanont Supoch, Attanavanich Sukasom, Straathof Chiara, Titulaer Maarten, Versteegh Michel, Pels Arda, Krum Yvonne, Leite M. Isabel, Hilton-Jones David, Ratnatunga Chandi, Newsom-Davis John, Farrugia Maria Elena, Petty Richard, Overell James, Kirk Alan, Gibson Andrew, McDermott Chris, Hopkinson David, Dot Marshall David Watling, Deborah Davies Sam Saminaden, Siva Sathasivam Charlotte Dougan, Page Richard, Jon Sussman, Ealing John, Krysiak Peter, Salajegheh Mohammad, Jaklitsch Michael, Roe Kristen, Ashizawa Tetsuo, Smith Robert Glenn, Zwischenberg Joseph, Stanton Penny, Jaradeh Safwan, Tisol William, Gasparri Mario, Haasler George, Yellick Mary, Dennis Cedric, Pasnoor Mamatha, Dimachkie Mazen, McVey April, Gronseth Gary, Dick Arthur, Kramer Jeffrey, Currence Melissa, Herbelin Laura, Belsh Jerry, Li Geoge, Langenfeld John, Mertz Mary Ann, Harrison Taylor, Force Seth, Usher Sharon, Lin Frank, DeMeester Steve, Akhter Salem, Malekniazi Ali, Avenido Gina, Crum Brian, Milone Margherita, Cassivi Stephen, Fisher Janet, Heatwole Chad, Watson Thomas, Hilbert James, Smirnow Alexis, Distad B. Jane, Weiss Michael, Wood Douglas, Haug Joanna, Ernstoff Raina, Cao Jingyang, Chmielewski Gary, Welsh Robert, Duris Robin, Gutmann Laurie, Pawar Gauri, Graeber Geoffrey Marc, Altemus Patricia, Nance Christopher, Gutmann Ludwig, Grogan Patrick, Calhoon John, Kittrell Pamela, Myers Deborah, Hayat Ghazala, Naunheim Keith, Eller Susan, Holzemer Eve, Alshekhlee Amer, Robke Jason, Karlinchak Brenda, Katz Jonathan, Miller Robert, Roan Ralph, Forshew Dallas, Elsheikh Bakri, Ross Patrick, Chelnick Sharon, Lewis Richard, Acsadi Agnes, Baciewicz Frank, Masse Stacey, Juel Vern, Onaitis Mark, Lowe James, Lipscomb Bernadette, Thai Gaby, Milliken Jeffrey, Martin Veronica, Karayan Ronnie, Muley Suraj, Parry Gareth, Shumway Sara, Oh Shin, Claussen Gwen, Lu Liang, Cerfolio Robert, Young Angela, Morgan Marla, Kincaid John, Kesler Kenneth, Guingrich Sandy, Michaels Angi, Phillips Lawrence, Burns Ted, Jones David, Fischer Cindy, Berger Alan, D’Agostino Harry, Smith Lisa, Pruitt Jerry, Landolfo Kevin, Hillman Demetric, Sermas Angelo, Ruel Ross, Ismail Farah, Sivak Mark, Goldstein Martin, Camunas Jorge, Bratton Joan, Panitch Hill, Leavitt Bruce, Jones Marilee, Muppidi Srikanth, Vernino Steven, Nations Sharon, Meyer Dan, Gorham Nina

Affiliations

¹ From the Departments of Neurology (I.L.) and Biostatistics (H.-C.K., I.B.A., G.R.C., T.M., G.M.), University of Alabama at Birmingham; Department of Neurology (H.J.K.), George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Neurology (J.S.), Greater Manchester Neuroscience Center, Salford, Greater Manchester, UK; Institute of Pathology (P.S.), University Medical Center Göttingen; Division of Neurology (J.O.), University of British Columbia, Vancouver, Canada; Department of Neurology (G.C.), University of Chile, Santiago; Division of Neurology (J.M.H.), Department of Medicine, University of Cape Town, South Africa; Department of Neurology (A.E.), Catholic University, Rome, Italy; Department of Neurology (W.N.), Johannes Gutenberg University, Mainz, Germany; Department of Neurology (E.C.), University of Rochester Medical Center, NY; Department of Neurosciences (G.A.), Mental Health and Sensory Organs, Sapienza University of Rome, Italy; Division of Neurology (R.W.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (J.O.K.), Royal Melbourne Hospital, Victoria, Australia; Department of Neurology (S.R.B.), University of Southern California, Los Angeles; Department of Neurology (C.H.C.), McGill University, Montreal, Canada; Department of Neurology (A.C.B.), Medical College of Wisconsin, Milwaukee; Department of Neurology (A.A.A.), Harvard Medical School, Boston, MA; Nerve and Muscle Center of Texas (A.I.S.), Houston; Department of Neurology (B.K.), Case Western Reserve University, Cleveland, OH; Walton Centre for Neurology and Neurosurgery (B.R.F.L.), Liverpool; Nuffield Department of Clinical Neurosciences (C.B., A.V.), Oxford University, UK; Unit of Neurology (E.D.-T.), University of Brasilia, Brazil; Department of Neurology (H.Y.), Kanazawa University, Japan; Department of Neurology (M.W.-C.), Federal University, Rio de Janeiro, Brazil; Department of Neurology (M.T.P.), University of Florida, Jacksonville; Department of Neurology (M.H.R.), Augusta University, GA; Department of Neurology (A.K.-P.), Medical University of Warsaw, Poland; Department of Neurology (R.M.P.), Indiana School of Medicine, Indianapolis; Department of Neurology (C.E.J.), University of Texas Health Science Center, San Antonio; Department of Neurology (J.J.G.V.), Leiden University Medical Center, the Netherlands; Department of Neurology (J.M.M.), Duke University Medical Center, Durham, NC; Department of Neurology (J.T.K.), Ohio State University Wexner Medical Center, Columbus; Department of Neurology (L.C.W.), Universidade Federal do Parana, Curitiba, Brazil; Department of Neurology (M.B.), University of Miami, FL; Department of Neurology (R.J.B.), University of Kansas Medical Center, Kansas City; Department of Neurological Sciences (R.T.), University of Vermont College of Medicine, Burlington; Department of Neurology (T.M.), University of California Irvine Medical Center, Orange; Division of Extramural Research (R.C.), NIH, National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of General Thoracic Surgery (J.R.S.), Columbia University Medical Center, New York; and Department of Neurology (G.I.W.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, NY. leeij15@gmail.com.
² From the Departments of Neurology (I.L.) and Biostatistics (H.-C.K., I.B.A., G.R.C., T.M., G.M.), University of Alabama at Birmingham; Department of Neurology (H.J.K.), George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Neurology (J.S.), Greater Manchester Neuroscience Center, Salford, Greater Manchester, UK; Institute of Pathology (P.S.), University Medical Center Göttingen; Division of Neurology (J.O.), University of British Columbia, Vancouver, Canada; Department of Neurology (G.C.), University of Chile, Santiago; Division of Neurology (J.M.H.), Department of Medicine, University of Cape Town, South Africa; Department of Neurology (A.E.), Catholic University, Rome, Italy; Department of Neurology (W.N.), Johannes Gutenberg University, Mainz, Germany; Department of Neurology (E.C.), University of Rochester Medical Center, NY; Department of Neurosciences (G.A.), Mental Health and Sensory Organs, Sapienza University of Rome, Italy; Division of Neurology (R.W.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (J.O.K.), Royal Melbourne Hospital, Victoria, Australia; Department of Neurology (S.R.B.), University of Southern California, Los Angeles; Department of Neurology (C.H.C.), McGill University, Montreal, Canada; Department of Neurology (A.C.B.), Medical College of Wisconsin, Milwaukee; Department of Neurology (A.A.A.), Harvard Medical School, Boston, MA; Nerve and Muscle Center of Texas (A.I.S.), Houston; Department of Neurology (B.K.), Case Western Reserve University, Cleveland, OH; Walton Centre for Neurology and Neurosurgery (B.R.F.L.), Liverpool; Nuffield Department of Clinical Neurosciences (C.B., A.V.), Oxford University, UK; Unit of Neurology (E.D.-T.), University of Brasilia, Brazil; Department of Neurology (H.Y.), Kanazawa University, Japan; Department of Neurology (M.W.-C.), Federal University, Rio de Janeiro, Brazil; Department of Neurology (M.T.P.), University of Florida, Jacksonville; Department of Neurology (M.H.R.), Augusta University, GA; Department of Neurology (A.K.-P.), Medical University of Warsaw, Poland; Department of Neurology (R.M.P.), Indiana School of Medicine, Indianapolis; Department of Neurology (C.E.J.), University of Texas Health Science Center, San Antonio; Department of Neurology (J.J.G.V.), Leiden University Medical Center, the Netherlands; Department of Neurology (J.M.M.), Duke University Medical Center, Durham, NC; Department of Neurology (J.T.K.), Ohio State University Wexner Medical Center, Columbus; Department of Neurology (L.C.W.), Universidade Federal do Parana, Curitiba, Brazil; Department of Neurology (M.B.), University of Miami, FL; Department of Neurology (R.J.B.), University of Kansas Medical Center, Kansas City; Department of Neurological Sciences (R.T.), University of Vermont College of Medicine, Burlington; Department of Neurology (T.M.), University of California Irvine Medical Center, Orange; Division of Extramural Research (R.C.), NIH, National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of General Thoracic Surgery (J.R.S.), Columbia University Medical Center, New York; and Department of Neurology (G.I.W.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, NY.

PMID: 32611638
PMCID: PMC7455358
DOI: 10.1212/WNL.0000000000010031

Abstract

Objective: To examine whether sustained minimal manifestation status (MMS) with complete withdrawal of prednisone is better achieved in thymectomized patients with myasthenia gravis (MG).

Methods: This study is a post hoc analysis of data from a randomized trial of thymectomy in MG (Thymectomy Trial in Non-Thymomatous Myasthenia Gravis Patients Receiving Prednisone Therapy [MGTX]). MGTX was a multicenter, randomized, rater-blinded 3-year trial that was followed by a voluntary 2-year extension for patients with acetylcholine receptor (AChR) antibody-positive MG without thymoma. Patients were randomized 1:1 to thymectomy plus prednisone vs prednisone alone. Participants were age 18-65 years at enrollment with disease duration less than 5 years. All patients received oral prednisone titrated up to 100 mg on alternate days until they achieved MMS, which prompted a standardized prednisone taper as long as MMS was maintained. The achievement rate of sustained MMS (no symptoms of MG for 6 months) with complete withdrawal of prednisone was compared between the thymectomy plus prednisone and prednisone alone groups.

Results: Patients with MG in the thymectomy plus prednisone group achieved sustained MMS with complete withdrawal of prednisone more frequently (64% vs 38%) and quickly compared to the prednisone alone group (median time 30 months vs no median time achieved, p < 0.001) over the 5-year study period. Prednisone-associated adverse symptoms were more frequent in the prednisone alone group and distress level increased with higher doses of prednisone.

Conclusions: Thymectomy benefits patients with MG by increasing the likelihood of achieving sustained MMS with complete withdrawal of prednisone.

Clinicaltrialsgov identifier: NCT00294658.

Classification of evidence: This study provides Class II evidence that for patients with generalized MG with AChR antibody, those receiving thymectomy plus prednisone are more likely to attain sustained MMS and complete prednisone withdrawal than those on prednisone alone.

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Figures

**Figure 1. Achievement of minimal manifestation status (MMS) in thymectomy plus prednisone and prednisone alone groups**

**Figure 2. Achievement of sustained minimal manifestation status (MMS) with complete withdrawal of prednisone in thymectomy plus prednisone and prednisone alone groups**

See this image and copyright information in PMC

References

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1. Mann JD, Johns TR, Campa JF, Muller WH. Long-term prednisone followed by thymectomy in myasthenia gravis. Ann NY Acad Sci 1976;274:608–622. - PubMed
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Minimal manifestation status and prednisone withdrawal in the MGTX trial

Collaborators

Affiliations

Minimal manifestation status and prednisone withdrawal in the MGTX trial

Authors

Collaborators

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Substances

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Research Materials