Immunoadsorption versus plasma exchange versus combination for treatment of myasthenic deterioration.

Schneider-Gold, Christiane; Krenzer, Marco; Klinker, Erdmute; Mansouri Taleghani, Behrouz; Müllges, Wolfgang; Toyka, Klaus V; Gold, Ralf (2016). Immunoadsorption versus plasma exchange versus combination for treatment of myasthenic deterioration. Therapeutic advances in neurological disorders, 9(4), pp. 297-303. Sage 10.1177/1756285616637046

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OBJECTIVES The goal of this study was to analyze safety and assess the efficacy of standard plasma exchange (PE) compared with immunoadsorption (IA) alone, or an alternating combination of both in deteriorating myasthenia gravis (MG). METHODS A total of 72 patients with MG who had received PE procedures for treatment of severe deterioration were retrospectively analyzed. They received either five cycles of PE (1-1.5 plasma volumes), or five cycles of IA in line with plasma separation, or a sequential alternating procedure of one cycle of PE followed by two cycles of IA, which was repeated once or more if needed. RESULTS A total of 19 patients received PE, 24 patients IA, and 29 the alternating combination therapy. All groups were equally distributed by sex and mean MG score before treatment. The number of treatment cycles and days on therapy did not differ between the groups. Mean MG scores at discharge were 3.0 (PE), 1.8 (IA) and 1.6 (combination) (p = 0.028 for combination versus PE). Inpatient time was 30.7 days (PE), 22.3 days (IA) and 20.0 days in combination therapy (p < 0.05 for combination versus PE). Side effects such as allergic reactions or hypocoagulability were significantly more frequent in the PE group (37% in PE versus 4% in IA and 3.6% in the alternating combination, p < 0.05). CONCLUSION Semiselective IA in combination with PE, and to a lesser extent IA alone, was associated with a shorter hospital stay and more pronounced reduction of the MG score than PE.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory

UniBE Contributor:

Mansouri Taleghani, Behrouz

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1756-2856

Publisher:

Sage

Language:

English

Submitter:

Katrin Kölliker-Schütz

Date Deposited:

06 Apr 2017 11:01

Last Modified:

07 Apr 2017 08:04

Publisher DOI:

10.1177/1756285616637046

PubMed ID:

27366236

Uncontrolled Keywords:

immunoadsorption; myasthenia gravis; myasthenic crisis; plasma exchange; therapy / Mansouri Taleghani Behrouz

BORIS DOI:

10.7892/boris.93675

URI:

https://boris.unibe.ch/id/eprint/93675

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