Plasmapheresis and Immunosuppressive Drug Therapy in Myasthenia Gravis

Abstract

Plasmapheresis combined with prednisone and azathioprine therapy produced striking clinical improvement in five patients with myasthenia gravis who still had moderate to severe disability despite thymectomy, high-dose prednisone therapy and optimal doses of cholinesterase inhibitors. Serial determinations of titers of serum antibody toward the acetylcholine receptor demonstrated a fall to 21 +/- 5 per cent (mean +/- S.D.) of the original levels concurrently with the patients' increasing strength. Clinically improved patients maintained lowered titers, whereas clinical relapses were associated with a rebound in titer. Our results suggest that plasmapheresis will find a place in the management of patients with myasthenia gravis, and they implicate antibodies to acetylcholine receptor as a pathogenic factor in this disease.

In vivo therapy with monoclonal anti-I-A antibody suppresses immune responses to acetylcholine receptor

“…The decrease in anti-AcChoR titers observed with in vivo anti-I-A therapy is greater than that achieved with other experimental therapies for myasthenia gravis such as cyclophosphamide and bone marrow transplantation in rats (11) or plasmapheresis and azathioprine in humans (12,13). The present experiments with anti-I-A antibody treatment revealed a 40% reduction of anti-AcChoR antibody titers after a severe challenge with AcChoR in complete Freund adjuvant, injected at multiple sites to induce disease.…”

Paraneoplastic Syndromes: An Approach to Diagnosis and Treatment

“…Concomitant administration of immune-modulating drugs appears to enhance the effect of plasmapheresis. 96 Depending on the timing of the procedure, consideration should be given to the possibility that plasmapheresis will increase drug clearance. 97 98 For select PNS, therapies directed at the resulting neuropathophysiologic process provide substantial clinical benefit.…”

Plasmapheresis in the Treatment of Neurologic Disorders in Bangladesh: A Review Update

“…It should be noted, however, that other mechanisms may exist. Indeed, PP can be looked upon as a ''blunderbuss'' that removes all the nonformed elements in plasma, including immunoglobulin, cytokines, and other serum factors, in a nonspecific fashion 8 . The specific factor whose removal is crucial in therapeutically successful PP is thus not specifically known.…”