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Making myasthenia less gravis
You have to be brave to organise a trial to confirm what we think we know, but have not yet proven. The trialists behind the single-blind, multi-centre, randomised trial comparing thymectomy and prednisolone to prednisone alone were braver still, seeing as it took them 6 years to accrue the 126 patients necessary to demonstrate the benefits of thymectomy. Those who had the operation had a lower ‘quantitative myasthenia gravis score’ (a new one on A Fo Ben, but lower is better), fewer needed immunosuppression or hospitalisation, and they were less distressed by their symptoms. These major landmark trials should be more routine and every patient should be expected to be entered in to a trial; not only for when we do not …
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