Although there appears to be a degree of correlation between autoantibody levels in patients with myasthenia gravis (MG) and disease severity, routine clinical use of autoantibody level testing is not recommended due to the limited evidence regarding the subject.

The role of autoantibodies directed towards nicotinic acetylcholine receptors, autoantibodies muscle-specific kinase, and low-density lipoprotein receptor-related protein 4 in the pathogenesis of MG has been long established. However, there is controversy regarding the potential clinical applications of these autoantibodies beyond diagnosis.

Currently, their use in clinical practice is variable, and the evidence regarding the subject is contradicting, with many studies suggesting that these antibodies have value as potential markers of disease severity and others suggesting that there is no correlation between autoantibody levels and severity. 

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These are among the findings in systematic review recently published in the European Journal of Neurology.

The authors aimed to investigate the relationship between autoantibodies and disease severity as well as to determine variables that could impact the way these antibodies influence patient management. 

The authors performed a systematic review in MEDLINE and Embase. Although a meta-analysis was initially planned, due to the heterogenicity between studies, descriptive analysis was used instead. Results were discussed by a group of 12 experts, who participated in a series of virtual meetings.

Out of 42 studies that met the eligibility criteria, 10 studies reported a correlation between autoantibody levels and disease activity. The remaining studies provided supportive data on autoantibody levels and disease outcomes but did not report correlation statistics.

Despite the fact that the majority of the included studies reported an important correlation between lower autoantibody levels and improved disease activity, there was a lack of consistent clinical outcome measures to assess MG severity, which compromised data analysis.

The authors believe that autoantibodies could potentially be used as a tool in the clinical management of MG. Nonetheless, in light of the scarce available evidence, the researchers do not recommend routine antibody testing at this time.

“Given the tentative evidence of a positive correlation between decreases in both measures, this research should build on the work to date and address the identified limitations, allowing a more definitive conclusion to be drawn,” the authors concluded.

Reference

Meisel A, Baggi F, Behin A, et al. The role of autoantibody levels as biomarkers in the management of patients with myasthenia gravis: a systematic review and expert appraisal. Eur J  Neurol. Published online September 12, 2022. doi:10.1111/ene.15565