Intervention Review

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Thymectomy for non-thymomatous myasthenia gravis

  1. Gabriel Cea1,*,
  2. Michael Benatar2,
  3. Renato J Verdugo3,
  4. Rodrigo A Salinas1

Editorial Group: Cochrane Neuromuscular Disease Group

Published Online: 14 OCT 2013

Assessed as up-to-date: 31 MAR 2013

DOI: 10.1002/14651858.CD008111.pub2

How to Cite

Cea G, Benatar M, Verdugo RJ, Salinas RA. Thymectomy for non-thymomatous myasthenia gravis. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD008111. DOI: 10.1002/14651858.CD008111.pub2.

Author Information

  1. 1

    Hospital del Salvador, Universidad de Chile, Departamento de Neurosciencias, Santiago, Chile

  2. 2

    University of Miami, Department of Neurology, Miami, Florida, USA

  3. 3

    Universidad del Desarrollo - Clínica Alemana, Servicio de Neurología, Facultad de Medicina, Santiago, Region Metropolitana of Santiago, Chile

*Gabriel Cea, Departamento de Neurosciencias, Hospital del Salvador, Universidad de Chile, Avda Salvador 364, Providencia, Santiago, 6640517, Chile.

Publication History

  1. Publication Status: New
  2. Published Online: 14 OCT 2013


Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Beekman 1997Retrospective case series

Beghi 1991Retrospective case series

Buckingham 1976Retrospective cohort type study

Donaldson 1990Retrospective case series

Durelli 1991Retrospective case series

Eaton 1955Retrospective case series and narrative review

Edwards 1972Retrospective case series

Emeryk 1976Retrospective case series

Grob 1987Retrospective case series

Henson 1965Retrospective case series

Kawaguchi 2007Retrospective cohort type study

Mack 1996Retrospective case series

Manlulu 2005Restrospective case series

Mantegazza 1990Retrospective case series

McQuillen 1977Narrative review published as guest editorial

Molly 2009Retrospective case series

Olanow 1987Retrospective case series

Oosterhuis 1981Retrospective case series

Papatestas 1987Retrospective case series

Perlo 1971Retrospective case series

Roberts 2001Retrospective case series

Rodriguez 1983Retrospective case series

Romi 2003Retrospective case series

Savcenko 2002Retrospective case series

Scadding 1985Retrospective case series

Simpson 1958Retrospective case series

Soleimani 2004Retrospective cohort type study

Tellez-Zenteno 2001Retrospective case series

Werneck 1991Retrospective case series

Yim 1995Retrospective case series

Zeldowicz 1969Retrospective case series

Characteristics of ongoing studies [ordered by study ID]

Trial name or titleA multicenter, single-blind, randomized study comparing thymectomy to no thymectomy in non-thymomatous myasthenia gravis (MG) patients receiving prednisone

MethodsBlinded RCT

ParticipantsPatients older than 18 years and younger than 65 years, with less than five years of MG, classified in stage II to IV according to the classification of the MGFA, with positive AChR antibodies, not taking immunosuppressants other than prednisone



Stage 1: Comparison of the prednisone protocol alone to prednisone protocol plus thymectomy, based on the clinical response to therapy measured over the 3 year trial period by the Area Under the Quantitative Myasthenia Gravis (QMG) weakness score (AUQMG)
Stage 2: Testing the difference in the total prednisone used over the 3-year trial period measured by pill count from blister packs Area Under the prednisone Dose Time Curve, (AUDTC), conditional on the results of comparing AUQMG


Frequency of treatment-associated complications and treatment-associated symptoms questionnaire score; Change in QMG and MG-ADL over time and at M12, M24 and M36; time from month 0 to reach initial Minimal Manifestation (MM) status; MM status at M12, M24 and M36; actual prednisone dose at M36; quality of life assessment (SF-36) at M12, M24 and M36; cumulative days in hospital for treatment of, or complications related to, MG by M24 and M36; number of plasmaphereses and IVIg infusions, and total dose of IVIg from M0 to M36

Starting date2006

Contact informationGury Cutter and Greg Minisman


Table 1. Outcomes for a 'Summary of findings' table

Thymectomy compared with non surgical treatment for myasthenia gravis

Patient or population: patients with non-thymomatous myasthenia gravis

Settings: inpatients and outpatients

Intervention: thymectomy

Comparison: any other available medical treatments used to treat MG, no treatment, or sham surgery


Improvement in myasthenic weakness within 12 months of thymectomy

Reduction by at least one third in the dose of corticosteroids within 12 months of thymectomy

Improvement in quality of life at 12 months or more after thymectomy

Pharmacological or complete remission, as defined by the Myasthenia Gravis Foundation of America (MGFA)

Death during three years of follow-up

Adverse events during three years of follow-up