Thymectomy for myasthenia gravis: what we know and what we don’t

In August 2016, the NEJM published the results of the MGTX prospective multicenter randomized trial comparing extended trans-sternal thymectomy and prednisone versus prednisone without surgery as primary treatment for myasthenia gravis (1). A total of 126 patients ranging in age from 18 to 65 years were randomized over 6 years at 36 sites. The thymectomy arm was statistically superior for both improved symptoms (as evidenced by a time-weighted average Quantitative Myasthenia score and less hospitalizations for exacerbations) and lower dose of both prednisone and azathioprine. This trial is of historic interest due to the accomplishment of completing such a trial in MG. It is also of interest due to the additional insight that it provides in regards to the contribution of surgery to treat a systemic disease.