Two-step nationwide epidemiological survey of myasthenia gravis in Japan 2018

PLoS One. 2022 Sep 21;17(9):e0274161. doi: 10.1371/journal.pone.0274161. eCollection 2022.

Abstract

Objective: To study the updated prevalence and clinical features of myasthenia gravis (MG) in Japan during 2017.

Methods: We sent survey sheets to the randomly selected medical departments (number = 7,545). First, we asked the number of MG patients who visited medical departments from January 1, 2017, to December 31, 2017. Then, we sent the second survey sheet to the medical departments that answered the first survey to obtain the clinical information of patients who received MG diagnosis between January 1, 2015, and December 31, 2017.

Results: The received answer to the first survey were 2,708 (recovery rate: 35.9%). After all, the prevalence of the 100,000 population was estimated as 23.1 (95%CI: 20.5-25.6). As a result of the second survey, we obtained 1,464 case records. After checking the duplications and lacking data, we utilized 1,195 data for further analysis. The median [interquartile range (IQR)] from the onset age of total patients was 59 (43-70) years old. The male-female ratio was 1: 1.15. The onset age [median (IQR)] for female patients was 58 (40-72) years old, and that for male patients was 60 (49-69) years old (Wilcoxon-Mann-Whitney test, p = 0.0299). We divided patients into four categories: 1) anti-acetylcholine receptor antibody (AChRAb) (+) thymoma (Tm) (-), 2) AChRAb(+)Tm(+), 3) anti-muscle-specific kinase antibody (MuSKAb) (+), and AChRAb(-)MuSKAb(-) (double negative; DN). The onset age [median (IQR)] of AChRAb(+)Tm(-) was 64 (48-73) years old, and AChRb(+)Tm(+) was 55 (45-66), MuSKAb(+) was 49 (36-64), DN was 47 (35-60) year old. The multivariate logistic regression analysis using sex, initial symptoms, repetitive nerve stimulation test (RNST), and edrophonium test revealed that sex, ocular symptoms, bulbar symptoms, and RNST were factors to distinguish each category. The myasthenia gravis activities of daily living profile at the severest state were significantly higher in MuSKAb(+). MuSKAb(+) frequently received prednisolone, tacrolimus plasmapheresis, and intravenous immunoglobulin; however, they received less acetylcholine esterase inhibitor. 99.2% of AChRAb(+)Tm(+) and 15.4% of AChRAb(+)Tm(-) received thymectomy. MuSKAb(+) did not receive thymectomy, and only 5.7% of DN received thymectomy. The prognosis was favorable in all categories.

Conclusion: Our result revealed that the prevalence of Japanese MG doubled from the previous study using the same survey method in 2006. We also found that the onset age shifted to the elderly, and the male-female ratio reached almost even. Classification in four categories; AChRAb(+)Tm(-), AChRAb(+)Tm(+), MuSKAb(+), and DN, well describe the specific clinical features of each category and differences in therapeutic approaches.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Adult
  • Aged
  • Autoantibodies
  • Edrophonium / therapeutic use
  • Esterases
  • Female
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Myasthenia Gravis* / epidemiology
  • Prednisolone / therapeutic use
  • Surveys and Questionnaires
  • Tacrolimus / therapeutic use
  • Thymectomy / methods
  • Thymoma*
  • Thymus Neoplasms*

Substances

  • Autoantibodies
  • Immunoglobulins, Intravenous
  • Edrophonium
  • Prednisolone
  • Esterases
  • Tacrolimus

Associated data

  • Dryad/10.5061/dryad.rxwdbrvcf

Grants and funding

This study is supported (in part) by a Health and Labour Sciences Research Grant on Rare and Intractable Diseases (Validation of Evidence-based Diagnosis and Guidelines, and Impact on QOL in Patients with Neuroimmunological Diseases) from the Ministry of Health, Labour and Welfare of Japan. The internal fund of Kanazawa University supported the rest of the expenses. There was no additional external funding received for this study. The funders had no role in the study design, data collection, analysis, publication decision, or manuscript preparation.