文献詳細
総説
文献概要
2016年8月に,胸腺腫を合併しない重症筋無力症(MG)に対する拡大胸腺摘除術の安全性と有効性に関する国際ランダム化比較試験(MGTX study)の結果が公表された。ステロイド治療に拡大胸腺摘除術を併用すると,QMGスコアの軽減,ステロイド総投与量の減量,治療に伴う症状や副作用を抑えてQOL(quality of life)向上をもたらすことが明らかになった。今後,この結果を踏まえ,MGの標準的治療の再検討が必要である。
参考文献
1)Wolfe GI, Kaminski HJ, Aban IB, Minisman G, Kuo HC, et al: Randomized trial of thymectomy in myasthenia gravis. N Engl J Med 375: 511-522, 2016
2)Schumacher ED, Roth M: Thymektomie bei einem Fall von Morbus Basedowi mit Myasthenie. Mitt Grenzgeb Med Chir 25: 746-765, 1913
3)Blalock A, Mason MF, Morgan HJ, Riven SS: Myasthenia gravis and tumors of the thymic region: report of a case in which the tumor was removed. Ann Surg 110: 544-561, 1939
4)Ettinger DS, Akerley W, Bepler G, Blum MG, Chang A, et al: Thymic malignancies. J Natl Compr Canc Netw 8: 1302-1315, 2010
5)Jaretzki A 3rd, Barohn RJ, Ernstoff RM, Kaminski HJ, Keesey JC, et al: Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Neurology 55: 16-23, 2000
6)Gronseth GS, Barohn RJ: Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 55: 7-15, 2000
7)Sanders DB, Hart IK, Mantegazza R, Shukla SS, Siddiqi ZA, et al: An international, phase III, randomized trial of mycophenolate mofetil in myasthenia gravis. Neurology 71: 400-406, 2008
8)Yoshikawa H, Kiuchi T, Saida T, Takamori M: Randomised, double-blind, placebo-controlled study of tacrolimus in myasthenia gravis. J Neurol Neurosurg Psychiatry 82: 970-977, 2011
9)Pasnoor M, He J, Herbelin L, Burns TM, Nations S, et al: A randomized controlled trial of methotrexate for patients with generalized myasthenia gravis. Neurology 87: 57-64, 2016
10)Palace J, Newsom-Davis J, Lecky B: A randomized double-blind trial of prednisolone alone or with azathioprine in myasthenia gravis. Myasthenia Gravis Study Group. Neurology 50: 1778-1783, 1998
掲載誌情報