Outcome of plasmapheresis in myasthenia gravis: Delayed therapy is not favorable

Mandawat, Aditya; Mandawat, Anant; Kaminski, Henry J.; Shaker, Zaid A.; Alawi, Aws; Alshekhlee, Amer

doi:10.1002/mus.21924

Cited by 23 publications

(24 citation statements)

References 28 publications

(28 reference statements)

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“…A potential limitation to the use of TPE is delay in starting therapy while waiting for CVC placement, which has been reported to increase the risk of complications 30. Congruent with a previous report, we found no significant delays in initiating TPE among patients who needed a CVC and no difference in the time to start TPE in patients with or without central lines 15…”

Section: Discussionsupporting

confidence: 71%

A Retrospective study of complications of therapeutic plasma exchange in myasthenia

et al. 2012

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Section: Discussionsupporting

confidence: 71%

A Retrospective study of complications of therapeutic plasma exchange in myasthenia

et al. 2012

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“…Given this rapid response, PLEX may be the preferred treatment in situations such as threatening myasthenic crisis. In such situations, PLEX should be provided within 2 days to limit mortality and decrease the complication rate of treatment …”

mentioning

confidence: 99%

“…In such situations, PLEX should be provided within 2 days to limit mortality and decrease the complication rate of treatment. 11 Although most reports have indicated that PLEX is a safe treatment with few side effects in MG patients, 3,12 including the elderly, 13 it is perceived to be a complex treatment that is difficult to prescribe, requires vascular access by central lines, and requires hospital admission. It has been suggested that MG patients who are elderly or have complex comorbid diseases might have better outcomes if IVIg is used rather than PLEX.…”

mentioning

confidence: 99%

Safety of plasma exchange therapy in patients with myasthenia gravis

2013

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“…[21][22][23] Randomized clinical studies carried out in adult populations comparing the efficacies of PLEX and IVIG demonstrate that they are generally comparable, with similar efficacies, durations of benefit, and safety profiles. 11,[24][25][26][27][28] While the effectiveness of PLEX and IVIG has been established in adult studies, our study is the first attempt to compare the role of PLEX vs IVIG as maintenance therapies for juvenile MG. In our study, we found significant differences in both objective and subjective improvements at follow-up clinic visits in the children with generalized juvenile MG who received PLEX vs IVIG vs combined treatments.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Plasmapheresis and Intravenous Immunoglobulin as Maintenance Therapies for Juvenile Myasthenia Gravis

et al. 2014

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IMPORTANCE Juvenile myasthenia gravis (MG) is a relatively rare autoimmune disorder. The comparative efficacy of plasmapheresis (PLEX) vs immunoglobulin as maintenance therapy is unclear for this childhood disease. OBJECTIVE To determine whether PLEX or intravenous immunoglobulin (IVIG) therapy is more effective as maintenance therapy in this disease. DESIGN, SETTING, AND PARTICIPANTS This retrospective analysis over a 33-year period involved 54 children and adolescents with juvenile MG at a specialized neuromuscular clinic and electromyography laboratory at a tertiary care academic pediatric hospital. INTERVENTIONS Plasmapheresis and IVIG. MAIN OUTCOMES AND MEASURES Response to treatment was measured by both improvement in objective physical examination findings and the patients' reported improvement in symptoms and functional abilities. RESULTS Subjective and objective outcomes correlated well. Both PLEX and IVIG had high response rates. Of the 27 patients with generalized juvenile MG receiving PLEX, IVIG, or both treatments, 7 of 7 patients treated with PLEX alone responded, 5 of 10 patients treated with IVIG alone responded, and 9 of 10 patients who received both responded. There was a significant difference in response rates between patients who received PLEX vs IVIG (P = .04). The youngest age at which PLEX was initiated via peripheral venous access was 9 years, while the youngest child who received IVIG was 9 months old. Thymectomy was performed in 17 children, of whom 11 experienced significant postoperative improvement. CONCLUSIONS AND RELEVANCE This study provides class III evidence that PLEX and IVIG both have high response rates as maintenance therapies and are reasonable therapeutic options for juvenile MG. Plasmapheresis may have a more consistent response rate than IVIG in this setting. These findings will provide some guidance regarding the approach to therapy for juvenile MG, especially as the results differ somewhat from those of studies focusing on adult MG.

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Outcome of plasmapheresis in myasthenia gravis: Delayed therapy is not favorable

Abstract: Delaying PLEX therapy for MG by more than 2 days after admission may lead to higher mortality and complication rates, and thus prompt therapy is warranted.

Cited by 23 publications

References 28 publications

A Retrospective study of complications of therapeutic plasma exchange in myasthenia

A Retrospective study of complications of therapeutic plasma exchange in myasthenia

Safety of plasma exchange therapy in patients with myasthenia gravis

Comparison of Plasmapheresis and Intravenous Immunoglobulin as Maintenance Therapies for Juvenile Myasthenia Gravis

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