Recurrent Thymoma With MG Effectively Treated With Methylprednisolone

Patients with recurrent thymoma with myasthenia gravis (MG) had better results when treated with methylprednisolone compared with docetaxel, but more patients reported adverse events, according to a new study.1 These results indicate that MG treatment should rely on patient preference to maximize quality of life.

MG is an autoimmune disease that causes impaired neuromuscular transmission and is likely related to abnormal immune response within the thymus.2 Approximately 20% to 50% of those with thymoma have MG,1 with surgery being the most common form of treatment. Systemic therapy is sometimes needed for recurrent thymoma when it is difficult to remove through surgery. This study aimed to assess the efficacy and safety of methylprednisolone pulse therapy compared with docetaxel treatment.

Methylprednisolone was more effective in treating recurrent thymoma with MG | Image credit: luchschenF - stock.adobe.com

Patients treated at the Center for MG Treatment at Shijiazhuang People’s Hospital between January 2019 and December 2023 had their data retrospectively collected for this analysis. Patients treated with either methylprednisolone pulse or docetaxel were eligible. Patients were included if they had confirmed pathological evidence of thymoma, symptoms of muscle weakness prior to treatment, and clinical and follow-up records available. Those with HIV, severe immune deficiencies, severe heart disease or mental disorders, a history of malignant tumors, or active tuberculosis were excluded.

Patients taking methylprednisolone started with an initial dose of 1 g that was reduced by half every 2 to 3 days. The patient would later switch to oral prednisone 60 mg that would be reduced by 10 mg per week until reaching 30 mg. These patients would stop taking medication after 6 to 12 months with a gradual decrease of prednisone dose. Those taking docetaxel would take it in a 75 mg/m2 dose on day 1 for a total of 2 cycles that lasted for 21 days each.

The efficacy of the treatments was measured using the Myasthenia Gravis Foundation of America Post-Intervention Status (MGFA-PIS), with minimal manifestation or higher considered effective. Complete remission of thymic tumor lesions was also used as a measure of efficacy of treatment.

There were 90 cases evaluated for this study, where the mean (SD) age was 48.64 (11.07) years and 40 were women. The mean duration of thymoma was 49.66 (38.34) months, and the mean duration of myasthenia gravis was 51.66 (43.34) months.

The mean Quantitative Myasthenia Gravis Score (QMGS) was 2.69 (2.44) in those who took methylprednisolone compared with 2.96 (2.71) in those who received docetaxel, both lower than before treatment. The 2 groups had no statistically significant difference between them. Overall response rate was 100% in the methylprednisolone group compared with 88.9% in the docetaxel group for treatment of MG. The objective response rate was 84.4% in the methylprednisolone group compared with 35.6% in the docetaxel group. The disease control rate was 97.8% in the methylprednisolone group compared with 69.2% in the docetaxel group.

A total of 30 patients in the methylprednisolone group and 20 in the docetaxel group reported adverse effects; 10 from the first group and 2 from the second group experienced 2 or more events simultaneously. Myelosuppression was the most commonly reported adverse effect. No statistically significant difference in adverse effects was found between the 2 groups.

There were some limitations to this study. This study was retrospective due to the rarity of MG combined with recurrent thymoma, which could have limited the analysis. The study was conducted at a single center, and the study sample was small, making it essential to confirm these results in a larger population.

“Our research shows that both docetaxel and methylprednisolone pulse can significantly alleviate MG symptoms in recurrent thymoma with MG, with no significant difference between the 2. However, methylprednisolone pulse is more effective in treating recurrent thymoma compared [with] docetaxel,” the authors concluded.

References

1. Yang H, Wang Y, Pan Z, Liu Z, Cheng B, Qi G. Methylprednisolone pulse versus docetaxel in recurrent thymoma with myasthenia gravis. Front Neurol. 2025;16:1615529. doi:10.3389/fneur.2025.1615529
2. Myasthenia gravis (MG). Cleveland Clinic. Updated November 10, 2023. Accessed January 12, 2026. https://my.clevelandclinic.org/health/diseases/17252-myasthenia-gravis-mg