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Diagnostic value of antibody concentration ratio for treatment-refractory myasthenia gravis

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Abstract

Objective

This study aimed to assess the diagnostic potential of the Antibody concentration ratio in identifying treatment-refractory myasthenia gravis (MG).

Methods

A retrospective analysis was conducted on 116 MG patients who underwent antibody detection at least twice between June 1, 2015, and June 1, 2023. Demographic and clinical characteristics were collated to ascertain their association with refractory MG. The Antibody Concentration Ratio was applied to determine treatment response, using the International Consensus Guidance criteria as the reference standard. The area under nonparametric receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy were calculated to assess the diagnostic efficacy of the Antibody concentration ratio following consecutive immunotherapy relative to initial antibody concentrations for refractory MG.

Results

19 out of 116 patients were unequivocally diagnosed with refractory MG. A significant correlation was found between the Antibody Concentration Ratio and refractory MG status in treatment-refractory and treatment-responsive patients. Subsequently, the AUC demonstrated the robust diagnostic capability of the Antibody concentration ratio for refractory MG, with an AUC of 0.8709 (95% CI: 0.7995–0.9422, p < 0.0001). The optimal cut-off value stood at 0.8903, exhibiting a sensitivity of 94.74% (95% CI: 75.36%-99.73%), a specificity of 68.04% (95% CI: 58.23%-76.48%), and accuracy of 72.41% (95% CI: 64.28%-80.54%).

Conclusion

Elevated Antibody Concentration Ratio is intrinsically linked with refractory MG and exhibits potential as an diagnostic biomarker for the condition.

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Data Availability

Data that support the findings of this study is availability. https://figshare.com/. https://doi.org/10.6084/m9.figshare.25287790.

Code availability

Not applicable.

Abbreviations

MG:

Myasthenia gravis

ROC:

Receiver operating characteristic

AChR:

Acetylcholine receptor

MuSK:

Muscle-specific tyrosine kinase

IVIG:

Intravenous immunoglobulin

PLEX:

Plasma exchange

QMGs:

The quantitative myasthenia gravis scores

MG-ADLs:

MG activities of daily living scores

ICG:

International Consensus Guidance

PASS:

Patient-acceptable symptom status

MGFA:

MG Foundation of America

AUC:

Area under the ROC curve

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Acknowledgements

This research was supported by the National Natural Science Foundation of China (grant number: 82171399).

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Authors and Affiliations

  1. Department of Neurology, Research Center for Neuroimmune and Neuromuscular disorders, **angya Hospital, Central South University, 87 **angya Road, Changsha, 410000, Hunan, China

    Yi Li, **aohua Dong, Weiwei Duan, Fei Jiang, Kangzhi Chen, Qian Zhou, Haobin Cai & Huan Yang

  2. **angya Hospital, Central South University, 87 **angya Road, Changsha, 410000, Hunan, China

    Shumei Yang

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  1. Yi Li
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Contributions

Huan Yang: conception, study design, revision of the manuscript; Yi Li: manuscript writing, interpretation of the results and collection of data; Shumei Yang: data collection and manuscript revision; **aohua Dong, Fei Jiang, Kangzhi Chen, Qian Zhou, Haobin Cai participated in the collection of data.

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Correspondence to Huan Yang.

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None of the authors has any conflict of interest to disclose.

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The study complied with the Declaration of Helsinki. All participants were informed and signed the consent form for the study and was approved by the Medical Ethics Committee of the Hunan Medical Science Research Institute of **angya Hospital (202103207).

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All participants were informed and signed the consent form for the study.

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Li, Y., Yang, S., Dong, X. et al. Diagnostic value of antibody concentration ratio for treatment-refractory myasthenia gravis. Neurol Sci (2024). https://doi.org/10.1007/s10072-024-07601-w

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