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Unsatisfactory outcomes in myasthenia gravis: influence by care providers

Dunand, Murielle
Borruat, Francois-Xavier
Spertini, Francois
Kuntzer, Thierry
Published in Journal of neurology. 2010, vol. 257, no. 3, p. 338-343
Abstract Myasthenia gravis (MG) can be difficult to treat despite an available therapeutic armamentarium. Our aim was to analyze the factors leading to unsatisfactory outcome (UO). To this end we used the Myasthenia Gravis Foundation of America classification system. Forty one patients with autoimmune MG were followed prospectively from January 2003 to December 2007. Outcomes were assessed throughout follow-up and at a final visit. 'Unchanged', 'worse', 'exacerbation' and 'died of MG' post-intervention status were considered UOs. During follow-up, UO rates reached 54% and were related to undertreatment (41%), poor treatment compliance (23%), infections (23%), and adverse drug effects (13%). The UO rate at final study assessment was 20%. UO during follow-up was significantly (P = 0.004) predictive of UOs at final assessment. When care was provided by neuromuscular (NM) specialists, patients had significantly better follow-up scores (P = 0.01). At final assessment UO rates were 7% and significantly better in patients treated by NM specialists, compared to other physicians where UO rates reached 27%. UO was a frequent finding occurring in more than half our patients during follow-up. Nearly two-thirds of the UOs could have been prevented by appropriate therapeutic adjustments and improved compliance. The differential UO rates at follow-up, their dependency on the degree to which the management was specialized and their correlation with final outcomes suggest that specialized MG care improves outcomes.
Keywords AdolescentAdultAgedAged, 80 and overAzathioprine/therapeutic useChildCholinesterase Inhibitors/therapeutic useClinical ProtocolsFemaleGlucocorticoids/therapeutic useHealth Personnel/standards/*statistics & numerical dataHumansImmunoglobulins, Intravenous/therapeutic useImmunosuppressive Agents/therapeutic useMaleMiddle AgedMortalityMyasthenia Gravis/*drug therapy/*mortality/surgeryNeurology/standards/statistics & numerical dataOutcome Assessment (Health Care)/*methodsPrednisone/therapeutic useProspective StudiesPyridostigmine Bromide/therapeutic useQuality of Health Care/standards/*statistics & numerical dataThymectomy/statistics & numerical dataTreatment FailureYoung Adult
PMID: 19760347
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Research group Etude de l'activation des monocytes/macrophages et des polynucléaires neutrophiles (779)
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DUNAND, Murielle et al. Unsatisfactory outcomes in myasthenia gravis: influence by care providers. In: Journal of neurology, 2010, vol. 257, n° 3, p. 338-343. doi: 10.1007/s00415-009-5318-9 https://archive-ouverte.unige.ch/unige:20919

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Deposited on : 2012-05-23

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