Costs and Charges for Plasma Exchange (PLEX) Versus Intravenous Immunoglobulin (IVIg) in the Treatment of Neuromuscular Disease (PD6.008)

Robinson, J S; Eccher, Matthew; Bengier, Amanda; Liberman, Joshua N.

doi:10.1212/wnl.78.1_meetingabstracts.pd6.008

Cited by 5 publications

(7 citation statements)

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“…MG is an auto-immune disease caused by the failure of neuromuscular transmission, due to binding of autoantibodies to proteins involved in signaling at the neuromuscular junction [9]. Although there may be no consistent correlation between anti-AChR antibody serum titers and MG disease severity, patients with generalized MG tend to have higher antibody titers in comparison to the patients with ocular MG, and in individual patients, serial antibody titers tend to correlate with disease status [7]. Also, Romi et al found a correlation between serum AChR antibody titers and severity of MG [10].…”

Section: Discussionmentioning

confidence: 99%

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Seropositivity in Myasthenia Gravis as a Predictor of Response to Therapeutic Plasma Exchange

Alemam

Abdulrahman

2019

J Neurol Res

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Background: In spite of the increasing availability of immunomodulatory treatments for myasthenia gravis (MG), little is known about factors that predict response to the treatment. We aim to study if the presence of acetylcholine receptor (AChR) antibodies may be one of the predictors of the response to the therapeutic plasma exchange (TPE) in patients with MG. Methods: The study was carried out in 78 patients with moderate to severe MG. They were divided into two groups: TPE group (62 patients) that included the patients who received TPE, and control (non-TPE) group who did not receive TPE and was only on medical treatment (16 patients). Patients in TPE group, then, were subdivided into sero-positive and sero-negative subgroups according to the presence or absence of AChR antibodies respectively. Scoring by Quantitative Myasthenia Gravis Scale (QMGS) was done before and 1 month after the TPE. Results: After 1 month of treatment, the change in QMGS was significantly higher in the TPE group than in the Non-TPE one (t =-6.406) (P < 0.0001). In the sero-positive group, the score of QMGS ranged initially from 19 to 34 (mean 26.48 ± 3.75) and after 1 month from 11 to 30 (mean 18.00 ± 4.45) with the median change of-32. The QMGS change was significantly greater in the sero-positive group than in the sero-negative one (t =-3.516) (P < 0.0001). Conclusions: As regards to the presence of AChR antibodies in patients with MG, both sero-positive and sero-negative groups responded to TPE but the sero-positive group had a better response.

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Section: Discussionmentioning

confidence: 99%

“…Although there is a greater accessibility to immunomodulatory treatments, little data is available for the predictors of response to treatment [6]. This may put some obstacles in choosing the most effective and economic treatment for individual cases [7].…”

Section: Introductionmentioning

confidence: 99%

Seropositivity in Myasthenia Gravis as a Predictor of Response to Therapeutic Plasma Exchange

Alemam

Abdulrahman

2019

J Neurol Res

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“…However, plasma exchange (PLEX) has considerable cost advantages over IVIg with a cost benefit ratio of 2 : 1 for treatment of myasthenia gravis [64]. …”

Section: Clinical Featuresmentioning

confidence: 99%

“…Compared to plasma exchange, IVIg is similar in terms of efficacy, mortality, and complications [ 63 ]. However, plasma exchange (PLEX) has considerable cost advantages over IVIg with a cost benefit ratio of 2 : 1 for treatment of myasthenia gravis [ 64 ].…”

Section: Clinical Featuresmentioning

confidence: 99%

Myasthenia Gravis: A Review

Trouth

Dabi

Solieman

et al. 2012

Autoimmune Diseases

111

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Acquired myasthenia gravis is a relatively uncommon disorder, with prevalence rates that have increased to about 20 per 100,000 in the US population. This autoimmune disease is characterized by muscle weakness that fluctuates, worsening with exertion, and improving with rest. In about two-thirds of the patients, the involvement of extrinsic ocular muscle presents as the initial symptom, usually progressing to involve other bulbar muscles and limb musculature, resulting in generalized myasthenia gravis. Although the cause of the disorder is unknown, the role of circulating antibodies directed against the nicotinic acetylcholine receptor in its pathogenesis is well established. As this disorder is highly treatable, prompt recognition is crucial. During the past decade, significant progress has been made in our understanding of the disease, leading to new treatment modalities and a significant reduction in morbidity and mortality.

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“…In addition, the cost of our therapy of plasmapheresis to hospitals and payors generally appears to be less than that of immunoglobulin therapy. 17 Therefore, even after a recombinant antidote for Xa inhibitors is approved for clinical use, plasmapheresis might still be a less expensive option. We think that this first reported case of successful plasmapheresis for apixaban toxicity warrants the initiation of multicenter registries to evaluate plasmapheresis as a reversal therapy for lifethreatening NOAC-induced bleeding.…”

Section: Discussionmentioning

confidence: 99%

Plasma Exchange for Urgent Apixaban Reversal in a Case of Hemorrhagic Tamponade after Pacemaker Implantation

Lam¹,

Reyes²,

Seger³

2015

Texas Heart Institute Journal

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We report the case of an 82-year-old A pixaban is a novel oral anticoagulant (NOAC) that is used to prevent stroke in patients who have nonvalvular atrial fibrillation (AF). This drug has predictable therapeutic levels that do not require laboratory monitoring; however, there is no specific antidote to reverse its toxicity.1,2 We present a case of hemorrhagic pericarditis and cardiac tamponade after pacemaker implantation in a patient who was taking apixaban because of AF. Novel therapy and subsequent treatment are discussed. Case ReportAn 82-year-old man with sick sinus syndrome and paroxysmal AF presented at our catheterization laboratory from the clinic, with near-syncope and bradycardia (CHADS 2 score, 2 of 6). On 24-hour Holter monitoring, the predominant result was sinus rhythm. An echocardiogram revealed a normal left ventricular ejection fraction (>0.60), grade II (pseudonormal) diastolic dysfunction, no significant valvular regurgitation, and normal pulmonary artery pressures. A dual-chamber permanent pacemaker was implanted to treat the patient's brady-tachy syndrome and because ventricular pacing revealed pacemaker syndrome (hypotension that results from ventricular pacing due to the absence of the atrial kick that normally increases stroke volume during atrioventricular synchrony). During the procedure, the atrial lead was repositioned. One day postoperatively, the patient was discharged from the hospital after undergoing chest radiography (with normal findings), device interrogation, and incision evaluation. Because of his stroke risk, he was prescribed apixaban (5 mg twice/d) at discharge. He had normal renal function (Table I) and a body weight of 172 lb.During the week after pacemaker implantation, the patient developed fatigue, a low-grade fever (99.2 °F), nausea, moderate pleuritic chest pain, and a productive cough with clear sputum. He was readmitted to the hospital. His blood pressure had decreased from 130/77 mmHg after pacemaker implantation to 100/68 mmHg upon readmission, when he was taking no antihypertensive medications. Physical examination revealed an irregular, tachycardic rhythm (100-130 beats/min), and distended neck veins; auscultation yielded diminished bibasilar breath sounds but no quiet heart sounds. Laboratory data revealed acute kidney injury (Table I) and a substantially elevated erythrocyte sedimentation rate and fibrinogen level. The patient's platelet count and coagulation times were normal; his hemoglobin level had decreased from 15 g/dL after pacemaker implantation to 12 g/dL on readmission. He was taken to the cardiac intensive care unit, where he remained hemodynamically stable.Computed axial tomograms (CT) of the chest (Fig. 1) were not conclusive for right ventricular free-wall perforation, although a moderate-to-large circumferential pericardial effusion of 1.7 cm was detected; its Hounsfield density suggested the presence of Case Reports

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Costs and Charges for Plasma Exchange (PLEX) Versus Intravenous Immunoglobulin (IVIg) in the Treatment of Neuromuscular Disease (PD6.008)

Cited by 5 publications

References 0 publications

Seropositivity in Myasthenia Gravis as a Predictor of Response to Therapeutic Plasma Exchange

Seropositivity in Myasthenia Gravis as a Predictor of Response to Therapeutic Plasma Exchange

Myasthenia Gravis: A Review

Plasma Exchange for Urgent Apixaban Reversal in a Case of Hemorrhagic Tamponade after Pacemaker Implantation

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