IMMUNOLOGY
It is important that the AChR antibody test provides the maximum sensitivity in order to single out patients with true MG and treat them, but it must also be specific enough to avoid over-diagnosing MG and subjecting patients to unnecessary trials of pyridostigmine and steroids
assay specificity to 100% based on the 48 healthy controls in the original verification, and would reduce the incidence of very- low positive results that the authors have been observing on their runs. The sensitivity (84.6%) at the higher
cut-off value of 0.6 nmol/L was deemed to be acceptable, given that 15% of patients with generalised MG do not show anti-AChR antibodies.5 The new cut-off of 0.6 nmol/L would bring the authors’ previously reported results for UK NEQAS sample 203-2 into consensus with the method group and with previous classifications when the same sample had been circulated before (as distributions 202-3 and 194- 1). Historical results for all UK NEQAS samples tested between January 2020 and January 2023 were re-assessed using
the proposed new cut-off, and the results remain in consensus with the targets (data not shown). This suggests that the new cut-off is suitable for implementation.
n The authors would like to thank the laboratory staff at the Greater Manchester Immunology Service for their ongoing hard work. They would also like to thank the neuro- ophthalmologists at the Manchester Royal Eye Hospital, the neurologists at Salford Royal Hospital and the immunologists at Manchester Royal Infirmary for their clinical input and assistance with this project.
References 1 O’Hare M, Doughty C. Update on Ocular
Myasthenia Gravis. Semin Neurol. 2019
Dec 17; 39 (06): 749–60. doi: 10.1055/s- 0039-1700527.
2 Melson AT, McClelland CM, Lee MS. Ocular myasthenia gravis: updates on an elusive target. Curr Opin Neurol. 2020 Feb; 33 (1): 55–61. doi: 10.1097/ WCO.0000000000000775.
3 Zisimopoulou P, Brenner T, Trakas N, Tzartos SJ. Serological diagnostics in myasthenia gravis based on novel assays and recently identified antigens. Autoimmun Rev. 2013 Jul; 12 (9): 924–30. doi: 10.1016/
j.autrev.2013.03.002.
4 Spillane J, Higham E, Kullmann DM. Myasthenia gravis. BMJ. 2012 Dec 21; 345: e8497. doi: 10.1136/bmj.e8497.
5 Meriggioli MN, Sanders DB. Autoimmune myasthenia gravis: emerging clinical and biological heterogeneity. Lancet Neurol. 2009 May; 8 (5): 475–90. doi: 10.1016/ S1474-4422(09)70063-8.
Rebecca Cottage, Immunology, Manchester Royal Infirmary (MRI); Dr Nouf Alnafisee, Neuro-Ophthalmology, Manchester Royal Eye Hospital; Dr Samuel Chee and Dr Tomaz Garcez, Immunology, MRI.
This article is based on a poster presented at the IBMS Congress 2023 event, held last September at the International Convention Centre in Birmingham.
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