AUTHOR=Jiang Ping , Li Jie , Li Hong-Yan , Zhang Bin , Yue Yao-Xian , Wang Su-Yun , Zi Xi-Cun , Liu Shuang-Shuang , Li Yi-Fan , Jiao Li-Dong , Li Hai-Feng 

TITLE=Minimal Manifestation Status Indicates a Stable State in Myasthenia Gravis: A Quantitative Study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.880045

DOI=10.3389/fneur.2022.880045

ISSN=1664-2295

ABSTRACT=Introduction: Minimal manifestation (MM) or better was recommended as the treatment goal for myasthenia gravis (MG). Sustainability of this status has not been described quantitatively in patients who had attained or close to it. 
Methods: Patients who were with no or slight impact on daily living were recruited and followed at baseline and 3, 6 and 12 months. Included patients were classified into 3 post-intervention status (PIS) categories: remission (R), MM and slight impact (SI). The proportion of patients belonging to real-time (considering the intervals between assessments) and sustained (not considering the intervals between assessments) PIS categories were compared at each follow-up. A sensitivity analysis (SA) cohort was established by including patients with PIS categories of all four follow-ups. QMGS, MG-ADL and MG-QOL15 scores in patients belonging to each PIS category at each follow-up were compared. The sustainability of R/MM status were examined and correlated with real-time R/MM status at follow-ups. 
Results: At baseline, 376 patients could be classified, including 55 as R (14.2%), 209 as MM (54.0%), and 112 as SI (28.9%). In whole cohort, 68.8~89.7%, 71~76.7% and 19.8~77.1% of patients classified into real-time R, MM and SI categories remained unchanged in each follow-up compared with the previous follow-up. The proportion of patients belonging to each real-time or sustained R/MM status at three follow-ups were 89.7~92.1% or 60.8~67%. In SA cohort, at least 86.4% of the baseline R/MM patients remained in R/MM status till 12 months. There were no differences in keeping real-time R/MM status at 6 or 12 months between patients with and without sustained R/MM status at 3 and 6 months. There were differences in QMGS, MG-ADL and MG-QOL15 scores among patients belonging to each real-time category at baseline and follow-ups, ranking as R