The combined use of intravenous immunoglobulins (IVIG) and plasma exchange can improve the consciousness, immune function, and prognosis of patients experiencing a myasthenia gravis (MG) crisis, according to a study published in Computational And Mathematical Methods in Medicine.

The study found that 100% of patients with MG crises who received both IVIG and plasma exchange had improvements in clinical efficacy while only 83.33% of patients receiving only plasma exchange showed improvement (P <.05).

Patients receiving both treatments also showed an improvement in absolute clinical scores going from a mean of 33.46 before treatment to a mean of 23.12 after treatment. No difference was observed in the plasma exchange-only group with a mean score of 33.68 before treatment and 33.19 after treatment.

A higher percentage of patients were also found to be conscious in the combined-treatment group 90% compared to the plasma exchange-only group (50%; P <.01). A total of 16.67% of patients in the plasma exchange-only group were in a coma compared to 0 in the combined-treatment group.

In the combined treatment group, immune function was improved in the plasma exchange-alone group with IgA, IgM, IgG, and GLB values all being statistically higher (P <.01). Acetylcholine receptor antibody and albumin levels, were also higher in the combined group while lymphocyte values were lower (P <.01 for all).

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Treatment with plasma exchange plus IVIG also resulted in a lower instance of adverse reactions than plasma exchange-only. Only 1 patient in the combined group had an adverse reaction compared to 5 in the plasma exchange-only group (P <.05). Patients receiving plasma exchange-only experienced nervous reaction in 1 patient, a gastrointestinal symptom in 1, systemic damage in 1, and a skin reaction in 2 patients. The only combined treatment patient to experience an adverse reaction experienced a skin reaction.

“The treatment of [MG crisis] with [plasma exchange] combined with immunoglobulin can not only effectively enhance patients’ consciousness and immune function but also effectively promote the prognosis, and the safety of treatment is guaranteed,” the authors said.

A total of 60 patients were enrolled in the study and split between the 2 treatment methods between February 2019 and April 2021. No significant difference was observed between the groups in terms of sex or age with an average age of 45.79 in the plasma exchange group and 45.13 in the plasma exchange plus IVIG group.

Reference

Peng X, Xie XB, Tan H, et al. Effects of plasma exchange combined with immunoglobulin therapy on consciousness, immune function, and prognosis in patients with myasthenia gravis crisis: a prospective randomized test. Comput Math Methods Med. Published online June 30, 2022. doi:10.1155/2022/7796833