{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T18:36:04Z","timestamp":1784054164990,"version":"3.55.0"},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,5,15]],"date-time":"2019-05-15T00:00:00Z","timestamp":1557878400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p><jats:italic>Introduction<\/jats:italic>: Some myasthenia gravis (MG) patients are refractory to conventional treatments. <jats:italic>Methods<\/jats:italic>: To describe the clinical features of refractory MG (RMG) and explore the association with human leukocyte antigen HLA\u2010DRB1 alleles, a cohort study of 114 consecutive MG patients was performed. Patients were classified as RMG based on predefined criteria. <jats:italic>Results<\/jats:italic>: Twenty\u2010two patients were found to have RMG (19.3%). There were no differences between non\u2010RMG and RMG patients with respect to sex, age of onset, abnormal 3\u2010Hz repetitive nerve stimulation, anti\u2010acetylcholine receptor antibody positivity, thymectomy, thymoma or thymic hyperplasia, and polyautoimmunity. HLA\u2010DRB1*03 was more frequent in the non\u2010RMG vs. control population (<jats:italic>P<\/jats:italic> = 3 \u00d7 10<jats:sup>\u22126<\/jats:sup>). The HLA\u2010DRB1*13 allele was less frequent in non\u2010RMG patients compared with controls (<jats:italic>P<\/jats:italic> = 0.002), and less frequent in the non\u2010RMG group compared with the RMG group (<jats:italic>P<\/jats:italic> = 0.003). <jats:italic>Discussion<\/jats:italic>: HLA\u2010DRB1*03 was more common in non\u2010RMG, and the HLA\u2010DRB1*13 allele appeared to have a protective role, as reported previously in other autoimmune disorders. <jats:italic>Muscle Nerve<\/jats:italic> <jats:bold>60<\/jats:bold>: 188\u2013191, 2019<\/jats:p>","DOI":"10.1002\/mus.26507","type":"journal-article","created":{"date-parts":[[2019,5,3]],"date-time":"2019-05-03T06:09:56Z","timestamp":1556863796000},"page":"188-191","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Refractory myasthenia gravis: Characteristics of a portuguese 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