Efficacy and safety of double-filtration plasmapheresis treatment of myasthenia gravis

Abstract

Objectives: To evaluate the efficacy of double-filtration plasmapheresis (DFPP) treatment of myasthenia gravis (MG) through a systematic review and meta-analysis. Methods: PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wanfang databases were searched for randomized controlled trials (RCTs) and clinical controlled trials (CCTs) on DFPP for MG from database establishment to June 2019. Two researchers independently screened the articles, extracted the data, and cross checked the results. RevMan 5.3 was used for statistical analyses. Results: Seven RCTs and 2 CCTs were found comprising 329 patients. The results showed that clinical MG remission rate after DFPP treatment was significantly higher (OR = 4.33; 95% confidence interval [CI], 1.97–9.53; P < .001) and the serum levels of antititin antibody was significantly decreased (standardized mean difference [SMD] = 9.30; 95% CI, 7.51–11.08; P < .001). In addition, the quantitative MG (QMG) score, hospital stay and time to remission of MG symptoms, and acetylcholine receptor antibody (AchRAb) decreased in the DFPP treatment group; however, these outcomes had high heterogeneity among the studies. Only one study has reported on the adverse effects, including hypotension and hematoma. Conclusion: This meta-analysis suggests that DFPP can be recommended for the short-term mitigation of MG. Because our review was limited by the quantity and quality of the included studies, the above conclusions should be verified by additional high-quality studies.

Our Clinical Experience in the Treatment of Myasthenia Gravis Acute Exacerbations with a Novel Nanomembrane-Based Therapeutic Plasma Exchange Technology

“…The clinical response of conventional TPE seems better in patients with higher MG scores [ 35 ], but more evidence is needed to confirm this finding with the novel mode of plasmapheresis as well. Likewise, further research is needed to confirm good efficacy in early-onset MG patients (<50 years) treated with double-filtration plasmapheresis [ 13 ] compared to early-onset MG patients (<50 years) treated with nanomembrane-based TPE ( Figure 1 ). The nanomembrane-based TPE was successfully used in a myasthenic patient suffering acute respiratory distress syndrome (ARDS) after pneumonia as well [ 36 ].…”

“…Therefore, there is an unmet need for targeted immunomodulatory therapies, which has resulted in an ongoing campaign to develop safer and more effective treatments for MG [ 11 ]. The technological advances for a direct removal of auto-antibodies in patients with MG, such as immunoabsorption [ 12 ], double-filtration plasmapheresis [ 13 ], and nanomembrane-based TPE technology [ 14 ], pose new challenges and perspectives in this context.…”

Double filtration plasmapheresis combined with rituximab for donor‐specific antibody desensitization in haploidentical haematopoietic stem cell transplantation

“…Compared to PE, DFPP provides a more selective large‐molecule removal, reduced need for plasma and increases the efficiency of purification 9,10 . Some reports have shown that DFPP was effective in the treatment for many immune‐related diseases such as myasthenia gravis 11 and antibodies desensitization in organ transplantation such as kidney transplantation 12,13 . However, there are no studies with large number of patients in DSA desensitization effect and outcome of DFPP treatment for Haplo‐HSCT patients.…”

Changes in Water Properties in Human Tissue after Double Filtration Plasmapheresis—A Case Study

“…The DFPP technique allows pathophysiological relevant molecules (e.g., circulating autoantigens, autoantibodies, circulating immune complexes, damaged proteins) and toxins (e.g., environmental toxins and toxins from microorganisms) to be removed from the blood of a subject. This blood cleaning procedure has been successfully used therapeutically in many diseases [2][3][4], including myasthenia gravis [5][6][7][8][9][10][11][12], chronic inflammatory demyelinating polyneuropathy [12], anti-glomerular basement membrane disease [13], hypoglycemia and hyperglycemia induced by insulin antibodies [14], pancreatitis induced by hypertriglyceridemia [15][16][17], Guillain-Barré syndrome [12,[18][19][20][21], Crow-Fukase syndrome [12], rheumatoid arthritis [22][23][24], chronic hepatitis C [25,26], pemphigus [27,28], bullous pemphigoid [29,30], atopic dermatitis [31], dermatomyositis [12], polymyositis [12], membranous nephropathy [32], acute thallotoxicosis [33], antibody-associated vasculitis [34][35][36], antisynthetase syndrome [37], diffuse proliferative lupus nephritis…”