Very late-onset myasthenia gravis: a systematic review and meta-analysis of sex distribution, thymic pathology and autoantibodies.

Authors

Ioannis Liampas, Silvia Demiri, Gerasimos Malataras, Antonis Polyviou, Vasileios Siokas, Dimitra Veltsista, Efthimios Dardiotis, Elisabeth Chroni

Published in

Journal of neurology. Volume 273. Issue 8. Jul 16, 2026. Epub Jul 16, 2026.

Abstract

We compared very late-onset myasthenia gravis (vloMG; onset ≥ 65 years) with MG beginning before age 65 years (non-vloMG) and contextualized these findings using the conventional early-onset (< 50 years, EOMG) versus late-onset (≥ 50 years, LOMG) classification.
MEDLINE, Embase, CENTRAL and Google Scholar were searched from inception through May 2026. Odds ratios (ORs) and 95% confidence intervals were pooled by age group for sex, AChR and MuSK antibody positivity, double-seronegativity, thymoma and thymic hyperplasia.
Eight studies were included. Compared with non-vloMG, vloMG showed higher AChR-antibody positivity (OR, 3.08; 2.23-4.26) and lower double-seronegativity (OR, 0.34; 0.24-0.48) and thymoma prevalence (OR, 0.25; 0.18-0.35). Pooled estimates suggested lower MuSK-antibody positivity (OR, 0.50; 0.26-0.98) and thymic hyperplasia prevalence (OR, 0.22; 0.03-1.66), although these associations did not meet the multiplicity-adjusted significance threshold. Female prevalence did not differ significantly (OR, 0.77; 0.54-1.09). Compared with EOMG, LOMG showed lower female (OR, 0.32; 0.18-0.56) and thymic hyperplasia prevalence (OR, 0.45; 0.33-0.62). AChR-antibody positivity (OR, 1.68; 1.16-2.45), MuSK-antibody positivity (OR, 0.59; 0.35-0.97), double-seronegativity (OR, 0.64; 0.41-0.99) and thymoma prevalence (OR, 0.48; 0.29-0.80) did not meet the multiplicity-adjusted significance threshold. Exploratory analysis showed higher titin-antibody positivity in LOMG (OR, 10.00; 3.03-33.33).
Advancing age at MG onset was associated with progressive enrichment of AChR-positive disease and declining MuSK positivity, seronegativity, and thymic pathology. These findings support subdivision into EOMG, intermediate-onset MG (50-64 years, IOMG) and vloMG.

PMID:
42461294
Bibliographic data and abstract were imported from PubMed on 17 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.