{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T22:53:40Z","timestamp":1774565620354,"version":"3.50.1"},"reference-count":39,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82571592"],"award-info":[{"award-number":["82571592"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82471426"],"award-info":[{"award-number":["82471426"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Optimal timing for treatment discontinuation in myasthenia gravis (MG) patients achieving minimal symptom expression (MSE) remains undefined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective cohort study enrolled 196 MG patients from the Huashan MG Registry who achieved MSE and subsequently discontinued all treatments. Cox regression was used to identify prognostic factors for relapse. Among these, 20 patients experienced two discontinuation events and were analyzed separately for their second discontinuation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Over a mean follow\u2010up of 111.10\u2009months, 108 patients (55.1%) experienced relapse. Multivariate analysis identified four independent prognostic factors: onset age\u2009\u2265\u200950\u2009years as a risk factor (HR 1.68, 95% CI 1.04\u20132.70,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.032), and rituximab administration (HR 0.43, 95% CI 0.17\u20130.89,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015), treatment duration \u2265\u200914.3\u2009months (HR 0.54, 95% CI 0.34\u20130.85,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008), and time from MSE to discontinuation \u2265\u20096.1\u2009months (HR 0.51, 95% CI 0.32\u20130.83,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007) as protective factors. Infection, fatigue, and psychological stress were common relapse triggers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Complete treatment discontinuation after MSE in MG carries substantial relapse risk. Individualized discontinuation decisions incorporating younger onset age, prior rituximab use, adequate treatment and consolidation duration may optimize outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ene.70569","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T13:31:18Z","timestamp":1773408678000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Who Can Safely Discontinue Treatment in Myasthenia Gravis? Insights From a Long\u2010Term Real\u2010World Study"],"prefix":"10.1111","volume":"33","author":[{"given":"Dingxian","family":"He","sequence":"first","affiliation":[{"name":"Huashan Rare Disease Centre and Department of Neurology, Huashan Hospital, Shanghai Medical College, National Centre for Neurological Disorders Fudan University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chong","family":"Yan","sequence":"additional","affiliation":[{"name":"Huashan Rare Disease Centre and Department of Neurology, Huashan Hospital, Shanghai Medical College, National Centre for Neurological Disorders Fudan University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baitong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Encephalopathy The Affiliated Hospital to Changchun University of Chinese Medicine  Jilin, Changchun China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanlei","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurology Southern Central Hospital of Yunnan Province (The First People's Hospital of Honghe Prefecture)  Gejiu Yunnan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shengying","family":"Gu","sequence":"additional","affiliation":[{"name":"Huashan Rare Disease Centre and Department of Neurology, Huashan Hospital, Shanghai Medical College, National Centre for Neurological Disorders Fudan University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianying","family":"Xi","sequence":"additional","affiliation":[{"name":"Huashan Rare Disease Centre and Department of Neurology, Huashan Hospital, Shanghai Medical College, National Centre for Neurological Disorders Fudan University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9033-7568","authenticated-orcid":false,"given":"Sushan","family":"Luo","sequence":"additional","affiliation":[{"name":"Huashan Rare Disease Centre and Department of Neurology, Huashan Hospital, Shanghai Medical College, National Centre for Neurological Disorders Fudan University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9481-1418","authenticated-orcid":false,"given":"Chongbo","family":"Zhao","sequence":"additional","affiliation":[{"name":"Huashan Rare Disease Centre and Department of Neurology, Huashan Hospital, Shanghai Medical College, National Centre for Neurological Disorders Fudan University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000539577"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102377\u201010\u201046"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.51792"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13760\u2010024\u201002552\u20107"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415\u2010020\u201009770\u2010y"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/17562864251319656"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.880045"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000011124"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/20406223221122538"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40478\u2010022\u201001454\u20100"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2016.4190"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneuroim.2021.577528"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.816243"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14039"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.11477\/mf.1416202555"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.27497"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13760\u2010022\u201002162\u20101"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1177249"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmd.2020.12.004"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.25052"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2025.111586"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmd.2023.02.013"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000008903"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2017.01960"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.00776"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2025.1608160"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2022.2887"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/CND.0000000000000420"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1212757"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1038\/ncpneuro0901"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20200513"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1038\/nri1886"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.593431"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.645"},{"key":"e_1_2_13_36_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.973813"},{"key":"e_1_2_13_37_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keab373"},{"key":"e_1_2_13_38_1","doi-asserted-by":"publisher","DOI":"10.1136\/lupus\u20102024\u2010001375"},{"key":"e_1_2_13_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2020.02.014"},{"key":"e_1_2_13_40_1","doi-asserted-by":"publisher","DOI":"10.1177\/17562864231213240"}],"container-title":["European Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ene.70569","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ene.70569","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ene.70569","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T22:13:30Z","timestamp":1774563210000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ene.70569"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":39,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1111\/ene.70569"],"URL":"https:\/\/doi.org\/10.1111\/ene.70569","archive":["Portico"],"relation":{},"ISSN":["1351-5101","1468-1331"],"issn-type":[{"value":"1351-5101","type":"print"},{"value":"1468-1331","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"2025-12-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70569"}}