Discussion
prednisone-responsive, treatment-resistant
This analysis has identified several important biosynthetic and catabolic pathways that are differentially expressed between treatment-responsive and treatment-resistant patients from the MGTX trial. Several shared pathways related to protein metabolism and lipid metabolism are altered across most outcome measures, however the physician-determined MMS and patient-reported MG-ADL groups were found to associate with distinct pathways. These results suggest that differences in patient-reported versus observer-reported outcomes contribute to these discrepancies. Together, our findings suggest reduced levels of certain metabolites and lipids at baseline may predict poor responses to prednisone treatment. How specific alterations in these pathways might contribute to corticosteroid resistance remains to be elucidated. Implementation of predictive models at 6 months will further distinguish between prednisone-responsive versus thymectomy-responsive biomarkers.