[Pubmed] Plasma exchange versus intravenous immunoglobulin in AChR subtype myasthenic crisis: A prospective cohort study
Posté : 11 juin 2022 12:00
Clin Immunol. 2022 Jun 8:109058. doi: 10.1016/j.clim.2022.109058. Online ahead of print.
ABSTRACT
Myasthenic crisis (MC) is a life-threatening state with respiratory failure in patients with myasthenia gravis (MG). The fast-acting immunomodulatory therapies for treating MC included plasma exchange (PE) and intravenous immunoglobulin (IVIG). However, the efficacy and the impact on antibody changes remained unknown. We prospectively followed 40 anti-acetylcholine receptors (AChR) antibody-positive MC patients who received either PE (n = 12) or IVIG (n = 28) at crisis. PE was associated with a reduced ICU stay length (p = 0.018) and an early response by the average changes in MGFA-QMG (p = 0.003), MMT (p = 0.020), and ADL (p = 0.011) at one-week off-ventilation. However, the clinical efficacy was equally comparable in both groups after 1 month. Post-treatment hemoglobin drop was significant in both groups, while IVIG was associated with a significant reduction in anti-AChR antibody titers (p < 0.001). This analysis provides real-world evidence in supporting the use of PE as a fast-acting therapy for shortening the ICU stay in AChR-associated MC.
PMID:35690385 | DOI:10.1016/j.clim.2022.109058
Source: https://pubmed.ncbi.nlm.nih.gov/3569038 ... 5&v=2.17.6