MG thymectomy: Influence of thymectomy on the course of myasthenia gravis and the role of the surgical procedures

Myasthenia gravis (MG) is a rare disease that leads to impaired signal transmission from the nerve to the muscles.

The cause of this disease is the formation of so-called autoantibodies against a protein molecule that is crucial for the transmission of signals at the neuromuscular synapse. It is known that an incorrectly regulated immune system is responsible for this, as these autoantibodies are not detectable in healthy people.

One of the organs of the immune system is the thymus gland. It is responsible for the maturation and differentiation of T lymphocytes, which play an important role in the defective regulation of the immune system.

In 10-15% of all MG patients, a tumor of the thymus gland (thymoma), which requires surgical removal, is detectable. Many patients show a significant improvement in their myasthenic symptoms after removal of the tumor. Many younger patients (up to 70 %) do not have a tumor. However, they show a typical change in the thymus. This is an expression of an active immunological process. It has also been shown that even in MG patients without a tumor, surgical removal of the thymus gland leads to an improvement in myasthenic symptoms (MGTX study).

The thymus gland can be removed using various surgical techniques. While minimally invasive procedures are superior to open surgical procedures in terms of tolerability, it has not yet been sufficiently clarified whether the procedures are equivalent in terms of their effect on myasthenia gravis and their safety, or whether one of the procedures is better.

With the Mya-Thymectomy study, we want to find an answer for this question.

The study will include 200 MG patients who have undergone minimally invasive thymectomy (Tmin group). Their data on the disease and therapy (in particular the thymectomy which were already performed) will then be compared with the data already analyzed from patients who have had an open thymectomy (MGTX study). In addition, we would like to survey 200 MG patients who have not undergone thymectomy (T0 group). A comparison with this patient group may provide information on the long-term effect of thymectomy.

By participating in this study, you can help to ensure that the care of MG patients - in particular the selection of treatment options - is better adapted to their needs in the future.

 

Contact: Frauke Stascheit (frauke.stascheit@charite.de)

Principle Investigator: Prof. Andreas Meisel & Dr. med. Frauke Stascheit - Klinik für Neurologie an der Charité Universitätsmedizin Berlin

Project Management: Prof. Andreas Meisel, Dr. Frauke Stascheit

Registration: DRKS (outstanding)

Course of the study: 12/2024-12/2025

Publications

  • Wolfe GI, Kaminski HJ, Aban IB, Minisman G, Kuo HC, Marx A, Ströbel P, Mazia C, Oger J, Cea JG, Heckmann JM, Evoli A, Nix W, Ciafaloni E, Antonini G, Witoonpanich R, King JO, Beydoun SR, Chalk CH, Barboi AC, Amato AA, Shaibani AI, Katirji B, Lecky BR, Buckley C, Vincent A, Dias-Tosta E, Yoshikawa H, Waddington-Cruz M, Pulley MT, Rivner MH, Kostera-Pruszczyk A, Pascuzzi RM, Jackson CE, Garcia Ramos GS, Verschuuren JJ, Massey JM, Kissel JT, Werneck LC, Benatar M, Barohn RJ, Tandan R, Mozaffar T, Conwit R, Odenkirchen J, Sonett JR, Jaretzki A 3rd, Newsom-Davis J, Cutter GR; MGTX Study Group. Randomized Trial of Thymectomy in Myasthenia Gravis. N Engl J Med. 2016 Aug 11;375(6):511-22. doi: 10.1056/NEJMoa1602489. Erratum in: N Engl J Med. 2017 May 25;376(21):2097. doi: 10.1056/NEJMx170003. [Dosage error in article text]. PMID: 27509100; PMCID: PMC5189669.
  • Kooshesh KA, Foy BH, Sykes DB, Gustafsson K, Scadden DT. Health Consequences of Thymus Removal in Adults. N Engl J Med. 2023 Aug 3;389(5):406-417. doi: 10.1056/NEJMoa2302892. PMID: 37530823; PMCID: PMC10557034.