Lower number of plasma exchange sessions and glomerular filtration rate decline are associated with second relapses in patients with myasthenia gravis

Premužić, Vedran; Bilić, Ervina; Šepec, Branimir Ivan; Hančević, Mirea; Bilić, Hrvoje; Sitaš, Barbara; Alfirev, Rujana Šprljan; Jelaković, Bojan

doi:10.1097/md.0000000000019100

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…22 There is evidence that increasing PLEX between 3 and 5 sessions results in a reduced rate of MG relapse during the ensuing 50 months. 23 A typical course of treatment in MC is often 5 PLEX sessions. 16 Data suggest that PLEX removes approximately 70% of intravascular IgG antibody per body volume exchanged and plateaus by 5 sessions.…”

Section: Discussionmentioning

confidence: 99%

Greater Number of Plasma Exchanges Does Not Improve Outcome in Myasthenic Crisis

Hansen

Neilson

Parikh

et al. 2023

Journal of Clinical Neuromuscular Disease

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Objectives:To determine the relationship between the number of plasma exchanges and clinical outcome in patients experiencing myasthenic crisis.Methods:We retrospectively reviewed all episodes of myasthenia gravis exacerbation/crisis who received plasmapheresis in patients admitted to a single-center tertiary care referral center from July 2008 to July 2017. We performed statistical analyses to determine whether the increased number of plasma exchanges improves the primary outcome (hospital length of stay) and the secondary outcome (disposition to home, skilled nursing facility, long-term acute care hospital, or death).Results:There is neither clinically observable nor statistically significant improvement in length of stay or disposition on discharge in patients who received 6 or greater sessions of plasmapheresis.Conclusions:This study provides class IV evidence that extending the number of plasma exchanges beyond 5 does not correlate with decreased hospital length of stay or improved discharge disposition in patients experiencing myasthenic crisis.

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Section: Discussionmentioning

confidence: 99%

Greater Number of Plasma Exchanges Does Not Improve Outcome in Myasthenic Crisis

Hansen

Neilson

Parikh

et al. 2023

Journal of Clinical Neuromuscular Disease

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show abstract

“…20 There is evidence that increasing PLEX between 3 and 5 sessions results in a reduced rate of MG relapse during the ensuing 50 months. 21 A typical course of treatment in MC is often five PLEX sessions. 12 Data suggest that PLEX removes about 70% of intravascular IgG antibody per body volume exchanged and plateaus by five sessions.…”

Section: Discussionmentioning

confidence: 99%

Number of plasma exchanges and outcome in myasthenic crisis

Neilson

Hansen

Parikh

et al. 2022

Preprint

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Background: Plasma exchange is an effective therapy for myasthenic crisis (MC); yet the number of exchanges needed is unknown. We set out to examine the relationship between the number of plasma exchanges and clinical outcome in patients experiencing MC. Methods: We retrospectively reviewed patient episodes with ICD 9 and ICD 10 codes for myasthenia gravis and myasthenia gravis exacerbation/crisis in patients admitted to a single center tertiary care referral center from July 2008 to July 2017. These episodes were screened for patients with impending myasthenia gravis crisis and manifest crisis who received plasmapheresis during their hospital course. We performed statistical analyses to determine if increased number of plasma exchanges improves the primary outcome (hospital length of stay), as well as the secondary outcome (disposition to home, skilled nursing facility, long term acute care hospital, or death). Results: There is neither clinically observable nor statistically significant improvement in length of stay or disposition on discharge in patients who received six or greater sessions of plasmapheresis. Conclusions: This study provides class IV evidence that extending the number of plasma exchanges beyond five does not correlate with decreased hospital length of stay or improved discharge disposition in patients experiencing myasthenic crisis.

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“…among acute MG patients and patients undergoing thymectomy [ 192 ]. Moreover, the high frequency of TPE, dysphagia and glomerular filtration rate (GFR) was found to be associated with MG relapses, and low GFR [ 193 ]. Thus, the TPE is a reliable treatment approach for MG yet more studies are required to improve its clinical efficacy and safety along with improving the demands of therapeutic procedures.…”

Section: Traditional Current and Emerging Therapeutic Approaches For ...mentioning

confidence: 99%

Myasthenia Gravis: Novel Findings and Perspectives on Traditional to Regenerative Therapeutic Interventions

Huang¹,

Wu²,

Wang³

et al. 2022

Aging and disease

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The prevalence of myasthenia gravis (MG), an autoimmune disorder, is increasing among all subsets of the population leading to an elevated economic and social burden. The pathogenesis of MG is characterized by the synthesis of autoantibodies against the acetylcholine receptor (AChR), low-density lipoprotein receptor-related protein 4 (LRP4), or muscle-specific kinase at the neuromuscular junction, thereby leading to muscular weakness and fatigue. Based on clinical and laboratory examinations, the research is focused on distinguishing MG from other autoimmune, genetic diseases of neuromuscular transmission. Technological advancements in machine learning, a subset of artificial intelligence (AI) have been assistive in accurate diagnosis and management. Besides, addressing the clinical needs of MG patients is critical to improving quality of life (QoL) and satisfaction. Lifestyle changes including physical exercise and traditional Chinese medicine/herbs have also been shown to exert an ameliorative impact on MG progression. To achieve enhanced therapeutic efficacy, cholinesterase inhibitors, immunosuppressive drugs, and steroids in addition to plasma exchange therapy are widely recommended. Under surgical intervention, thymectomy is the only feasible alternative to removing thymoma to overcome thymoma-associated MG. Although these conventional and current therapeutic approaches are effective, the associated adverse events and surgical complexity limit their wide application. Moreover, Restivo et al. also, to increase survival and QoL, further recent developments revealed that antibody, gene, and regenerative therapies (such as stem cells and exosomes) are currently being investigated as a safer and more efficacious alternative. Considering these above-mentioned points, we have comprehensively reviewed the recent advances in pathological etiologies of MG including COVID-19, and its therapeutic management.

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Lower number of plasma exchange sessions and glomerular filtration rate decline are associated with second relapses in patients with myasthenia gravis

Cited by 4 publications

References 21 publications

Greater Number of Plasma Exchanges Does Not Improve Outcome in Myasthenic Crisis

Greater Number of Plasma Exchanges Does Not Improve Outcome in Myasthenic Crisis

Number of plasma exchanges and outcome in myasthenic crisis

Myasthenia Gravis: Novel Findings and Perspectives on Traditional to Regenerative Therapeutic Interventions

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