{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:53:13Z","timestamp":1786978393228,"version":"build-2736575974"},"reference-count":15,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T00:00:00Z","timestamp":1646784000000},"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":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction\/Aims<\/jats:title>\n                    <jats:p>A subgroup of myasthenia gravis (MG) patients fail to respond adequately to recommended treatments, a condition referred to as refractory MG. During the refractory phase, patients experience persistent debilitating symptoms with potential life\u2010threatening events or inability to reduce immunosuppressant dosages and minimize long\u2010term toxicities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective, single\u2010center study of 113 MG patients to investigate the autoantibody profile and clinical characteristics of refractory MG patients, compared with nonrefractory patients, based on predefined criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifteen patients (13.3%) were classified as refractory. Double\u2010seronegative MG (DSNMG), without detectable nicotinic acetylcholine receptor (AChR) or muscle\u2010specific tyrosine kinase (MuSK) antibodies, was identified in six refractory patients, significantly higher than those with nonrefractory MG (40% vs 16.3%;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.031). None of the refractory patients had MuSK antibodies. Patients in the refractory group more frequently had an earlier disease onset, thymic pathology, and thymectomy (\n                      <jats:italic>P<\/jats:italic>\n                      \u2264. 03 for all).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>In this study, patients with refractory MG were more likely than those with nonrefractory MG to be DSN; and refractory DSNMG patients had worse MGFA classes in their recent visit compared with anti\u2010AChR positive refractory patients. Refractory DSNMG patients may represent a distinct group that requires more individualized and targeted treatment approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mus.27521","type":"journal-article","created":{"date-parts":[[2022,2,23]],"date-time":"2022-02-23T11:33:45Z","timestamp":1645616025000},"page":"607-611","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Autoantibody profile in myasthenia gravis patients with a refractory phase"],"prefix":"10.1002","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5559-6820","authenticated-orcid":false,"given":"Dimitra","family":"Veltsista","sequence":"first","affiliation":[{"name":"Neuromuscular Center, Department of Neurology University of Patras  Patras Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zinovia","family":"Kefalopoulou","sequence":"additional","affiliation":[{"name":"Neuromuscular Center, Department of Neurology University of Patras  Patras Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Tzartos","sequence":"additional","affiliation":[{"name":"Second Department of Neurology School of Medicine, National and Kapodistrian University of Athens, \u201cAttikon\u201d University Hospital  Athens Greece"},{"name":"Tzartos NeuroDiagnostics  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9237-4963","authenticated-orcid":false,"given":"Elisabeth","family":"Chroni","sequence":"additional","affiliation":[{"name":"Neuromuscular Center, Department of Neurology University of Patras  Patras Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,9]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/1756285617749134"},{"issue":"2","key":"e_1_2_10_3_1","first-page":"255","article-title":"Clinical characteristics of refractory myasthenia gravis patients","volume":"86","author":"Suh J","year":"2013","journal-title":"Yale J Biol Med."},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.3205\/000239"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-019-09667-5"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.55.1.16"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000004341"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/1756286419832242"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002790"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14675"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/CND.0000000000000034"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.25597"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000011124"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.26985"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.314"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.596621"}],"container-title":["Muscle &amp; Nerve"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mus.27521","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/mus.27521","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mus.27521","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T16:08:00Z","timestamp":1692979680000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/mus.27521"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,9]]},"references-count":15,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,5]]}},"alternative-id":["10.1002\/mus.27521"],"URL":"https:\/\/doi.org\/10.1002\/mus.27521","archive":["Portico"],"relation":{},"ISSN":["0148-639X","1097-4598"],"issn-type":[{"value":"0148-639X","type":"print"},{"value":"1097-4598","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,9]]},"assertion":[{"value":"2021-09-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-02-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-09","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}