1. Clinical features of LRP4/agrin‐antibody–positive myasthenia gravis: A multicenter study
- Author
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Ikjae Lee, Mazen M. Dimachkie, Andrea M. Corse, Carlayne E. Jackson, Hongyan Xu, Jerry M. Belsh, J. Americo Fernandes, Mamatha Pasnoor, Tuan Vu, Eroboghene E. Ubogu, James F. Howard, George A. Small, Robert P. Lisak, R. Bhavaraju Sanka, Vanessa Baute, James Caress, Lin Mei, Stephen N. Scelsa, Brandy Quarles, Zachary Simmons, Richard Nowak, Zheng Yu, Richard J. Barohn, Jin-Xiu Pan, Clifton L. Gooch, Michael H. Rivner, and Andrea Swenson
- Subjects
0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,clinical features ,Physiology ,LRP4 ,neuromuscular transmission disorders ,Class iii ,030105 genetics & heredity ,Gastroenterology ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,Neuromuscular Transmission Disorders ,Physiology (medical) ,Internal medicine ,seronegative myasthenia gravis ,medicine ,Prevalence ,Humans ,LDL-Receptor Related Proteins ,Clinical Research Articles ,Autoantibodies ,Clinical Research Article ,myasthenia gravis ,Agrin ,biology ,business.industry ,Middle Aged ,Clinical disease ,medicine.disease ,Myasthenia gravis ,United States ,Multicenter study ,biology.protein ,Female ,Neurology (clinical) ,Antibody ,Symptom Assessment ,business ,Standard therapy ,agrin ,030217 neurology & neurosurgery - Abstract
Introduction Our aim in this study was to identify the prevalence and clinical characteristics of LRP4/agrin‐antibody–positive double‐seronegative myasthenia gravis (DNMG). Methods DNMG patients at 16 sites in the United States were tested for LRP4 and agrin antibodies, and the clinical data were collected. Results Of 181 DNMG patients, 27 (14.9%) were positive for either low‐density lipoprotein receptor–related protein 4 (LRP4) or agrin antibodies. Twenty‐three DNMG patients (12.7%) were positive for both antibodies. More antibody‐positive patients presented with generalized symptoms (69%) compared with antibody‐negative patients (43%) (P ≤ .02). Antibody‐positive patients’ maximum classification on the Myasthenia Gravis Foundation of America (MGFA) scale was significantly higher than that for antibody‐negative patients (P ≤ .005). Seventy percent of antibody‐positive patients were classified as MGFA class III, IV, or V compared with 39% of antibody‐negative patients. Most LRP4‐ and agrin‐antibody–positive patients (24 of 27, 89%) developed generalized myathenia gravis (MG), but with standard MG treatment 81.5% (22 of 27) improved to MGFA class I or II during a mean follow‐up of 11 years. Discussion Antibody‐positive patients had more severe clinical disease than antibody‐negative patients. Most DNMG patients responded to standard therapy regardless of antibody status.
- Published
- 2020