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Objectives <p>We compared very late-onset myasthenia gravis (vloMG; onset ≥ 65&#xa0;years) with MG beginning before age 65&#xa0;years (non-vloMG) and contextualized these findings using the conventional early-onset (&lt; 50&#xa0;years, EOMG) versus late-onset (≥ 50&#xa0;years, LOMG) classification.</p> Methods <p>MEDLINE, Embase, CENTRAL and Google Scholar were searched from inception through May 2026. Odds ratios (ORs) and 95% confidence intervals were pooled by age group for sex, AChR and MuSK antibody positivity, double-seronegativity, thymoma and thymic hyperplasia.</p> Results <p>Eight studies were included. Compared with non-vloMG, vloMG showed higher AChR-antibody positivity (OR, 3.08; 2.23–4.26) and lower double-seronegativity (OR, 0.34; 0.24–0.48) and thymoma prevalence (OR, 0.25; 0.18–0.35). Pooled estimates suggested lower MuSK-antibody positivity (OR, 0.50; 0.26–0.98) and thymic hyperplasia prevalence (OR, 0.22; 0.03–1.66), although these associations did not meet the multiplicity-adjusted significance threshold. Female prevalence did not differ significantly (OR, 0.77; 0.54–1.09). Compared with EOMG, LOMG showed lower female (OR, 0.32; 0.18–0.56) and thymic hyperplasia prevalence (OR, 0.45; 0.33–0.62). AChR-antibody positivity (OR, 1.68; 1.16–2.45), MuSK-antibody positivity (OR, 0.59; 0.35–0.97), double-seronegativity (OR, 0.64; 0.41–0.99) and thymoma prevalence (OR, 0.48; 0.29–0.80) did not meet the multiplicity-adjusted significance threshold. Exploratory analysis showed higher titin-antibody positivity in LOMG (OR, 10.00; 3.03–33.33).</p> Discussion <p>Advancing age at MG onset was associated with progressive enrichment of AChR-positive disease and declining MuSK positivity, seronegativity, and thymic pathology. These findings support subdivision into EOMG, intermediate-onset MG (50–64&#xa0;years, IOMG) and vloMG.</p>

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Very late-onset myasthenia gravis: a systematic review and meta-analysis of sex distribution, thymic pathology and autoantibodies

  • 期刊论文

  • 发表日期：

    2026年7月16日

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  • Ioannis Liampas,
  • Silvia Demiri,
  • Gerasimos Malataras,
  • Antonis Polyviou,
  • Vasileios Siokas,
  • Dimitra Veltsista,
  • Efthimios Dardiotis,
  • Elisabeth Chroni

摘要

Objectives

We compared very late-onset myasthenia gravis (vloMG; onset ≥ 65 years) with MG beginning before age 65 years (non-vloMG) and contextualized these findings using the conventional early-onset (< 50 years, EOMG) versus late-onset (≥ 50 years, LOMG) classification.

Methods

MEDLINE, Embase, CENTRAL and Google Scholar were searched from inception through May 2026. Odds ratios (ORs) and 95% confidence intervals were pooled by age group for sex, AChR and MuSK antibody positivity, double-seronegativity, thymoma and thymic hyperplasia.

Results

Eight studies were included. Compared with non-vloMG, vloMG showed higher AChR-antibody positivity (OR, 3.08; 2.23–4.26) and lower double-seronegativity (OR, 0.34; 0.24–0.48) and thymoma prevalence (OR, 0.25; 0.18–0.35). Pooled estimates suggested lower MuSK-antibody positivity (OR, 0.50; 0.26–0.98) and thymic hyperplasia prevalence (OR, 0.22; 0.03–1.66), although these associations did not meet the multiplicity-adjusted significance threshold. Female prevalence did not differ significantly (OR, 0.77; 0.54–1.09). Compared with EOMG, LOMG showed lower female (OR, 0.32; 0.18–0.56) and thymic hyperplasia prevalence (OR, 0.45; 0.33–0.62). AChR-antibody positivity (OR, 1.68; 1.16–2.45), MuSK-antibody positivity (OR, 0.59; 0.35–0.97), double-seronegativity (OR, 0.64; 0.41–0.99) and thymoma prevalence (OR, 0.48; 0.29–0.80) did not meet the multiplicity-adjusted significance threshold. Exploratory analysis showed higher titin-antibody positivity in LOMG (OR, 10.00; 3.03–33.33).

Discussion

Advancing age at MG onset was associated with progressive enrichment of AChR-positive disease and declining MuSK positivity, seronegativity, and thymic pathology. These findings support subdivision into EOMG, intermediate-onset MG (50–64 years, IOMG) and vloMG.