Clinical features of LRP4/agrin‐antibody–positive myasthenia gravis: A multicenter study

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 co...

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Published in:Muscle & nerve 2020-09, Vol.62 (3), p.333-343
Main Authors: Rivner, Michael H., Quarles, Brandy M., Pan, Jin‐Xiu, Yu, Zheng, Howard, James F., Corse, Andrea, Dimachkie, Mazen M., Jackson, Carlayne, Vu, Tuan, Small, George, Lisak, Robert P., Belsh, Jerry, Lee, Ikjae, Nowak, Richard J., Baute, Vanessa, Scelsa, Stephen, Fernandes, J. Americo, Simmons, Zachary, Swenson, Andrea, Barohn, Richard, Sanka, R. Bhavaraju, Gooch, Clifton, Ubogu, Eroboghene, Caress, James, Pasnoor, Mamatha, Xu, Hongyan, Mei, Lin
Format: Article
Language:English
Subjects:
Agrin
Antibodies
Clinical
clinical features
Clinical s
LRP4
Myasthenia
Myasthenia gravis
Neuromuscular junctions
neuromuscular transmission disorders
Patients
Receptor density
seronegative myasthenia gravis
Signs and symptoms
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Summary: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.
ISSN:0148-639X
1097-4598
DOI:10.1002/mus.26985