Lymphoplasma exchange is an effective treatment for patients with myasthenia gravis who are in a state of exacerbation or in preparation for a thymectomy, according to a new retrospective study performed in a Chinese center.

According to the authors of the study, published in Frontiers in Immunology, the early use of lymphoplasma exchange on early-onset myasthenia gravis “may have good therapeutic effects.”

Lymphoplasma exchange is an approach that combines plasma exchange with leukapheresis. It has been yielding promising results in the treatment of autoimmune diseases, but its safety and efficacy in patients with myasthenia gravis have not been thoroughly studied. 

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Here, a team of researchers from Changsha, China reviewed the safety, clinical efficacy, and immunological characteristics of lymphoplasma exchange treatment in patients with myasthenia gravis.

The researchers evaluated 276 patients with generalized myasthenia gravis, aged 28 to 63 years, who were in a state of exacerbation, including those with impeding crisis or myasthenic crisis and those who were preparing for thoracic exsection. The patients underwent a total of 635 lymphoplasma exchange sessions between them. 

The results showed that the patients’ Quantitative Myasthenia Gravis, Myasthenia Gravis Specific Manual Muscle Testing, activities of daily living, and quality of life scores all improved during the 4 weeks following lymphoplasma exchange.

Adverse events occurred in 20 of the 276 patients. Independent predictive factors for a good response to treatment were symptom onset less than 3 days prior to lymphoplasma exchange therapy and age of under 50 years. 

Four weeks after the first treatment, serum levels of antibodies, immunoglobulins, and complement decreased, as did the levels of interleukin (IL)-17A and interferon (IFN)-γ. On the contrary, IL-10 levels increased. The researchers concluded that lymphoplasma exchange is likely polarizing cytokines from IL-17A and IFN-γ into IL-10.

They added that their findings must be confirmed in future randomized controlled trials.

Reference

Ouyang S, Yin W, Zeng Q, et al. Lymphoplasma exchange improves myasthenia gravis exacerbations: a retrospective study in a Chinese center. Front Immunol. 2022;13:757841. doi:10.3389/fimmu.2022.757841