• late-onset myasthenia gravis
• myasthenia gravis
• thymectomy

Thymectomy is a well-established treatment in non-thymomatous AChR antibody-positive generalized Myasthenia Gravis (MG) patients aged 18-50 years. However, the MGTX trial failed to prove a significant benefit of thymectomy in the subgroup of Late Onset MG (LOMG) patients (aged over 50), and studies conducted so far have shown controversial results. Given the increasing incidence of MG in adults over 50 years of age in recent decades, further evidence is warranted to address the therapeutic unmet needs of this population. The aim of the present study was therefore to evaluate and compare the long-term effectiveness of thymectomy versus medical therapy alone in a cohort of LOMG patients (n=127, mean age at onset 60.2 years). We retrospectively analyzed and compared neurological outcomes between 87 LOMG thymectomized patients and 40 patients treated with medical therapy alone, with a mean follow-up period of 4.5 years. At the last follow-up, disease remission (both complete clinical and pharmacological remission) was attained in 47% of thymectomized patients and 17.5% of patients in the conservative group. After adjustment for age, sex, and disease severity, the thymectomy group had a 3.81-fold increased probability of achieving disease remission than the conservative group (HR = 3.81, 95% CI 1.48–9.83). Despite the limitations inherent to the study design, our results strongly suggest that thymectomy should be considered as a valid therapeutic option even for the LOMG subtype.