Outcome of therapeutic plasma exchange in Myasthenia gravis patients

Dogra, Ashu; Rana, Kaushik; Rathod, Chirag; Prakash, Sanjay

doi:10.4103/jfmpc.jfmpc_1026_20

Cited by 4 publications

(4 citation statements)

References 29 publications

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“…By rapidly removing circulating AChR-Ab antibodies, TPE can improve myasthenia symptoms and reduce hospitalization mortality. 18,19 An existing study involving ten patients with crisis underwent TPE with a median of 6 times (5 to 27 times). At the end of the TPE course, AChR-Ab level decreased by an average of 71% and their symptoms improved.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Plasma Exchange in AChR-Ab Positive Generalized Myasthenia Gravis: A Real World Study About Its Early Response

Chen,

Feng,

et al. 2024

JIR

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Background: Since there is no clear priority or selection principle in the guidelines for myasthenia crisis, therapeutic plasma exchange (TPE) and intravenous immunoglobulin are often administered randomly. However, it should be more prudent in taking TPE due to its higher cost and risk. Studying its early response factors is crucial for managing myasthenia crisis and can improve medical and economic benefits. Methods: A prospective observational study was conducted, and patients classified as having "impending myasthenia crisis" or experiencing a myasthenia crisis and treated by TPE were included. The primary endpoint was the response after TPE. Univariate logistic regression analysis and repeated measurement were performed to analyze factors related to TPE efficacy. Results: A total of 30 patients who treated with TPE as their fast-acting treatments were enrolled. After TPE, those whose QMGs and/ or MGCs decreased by ≥5 points or ≥30% of the baseline were judged as "response group", accounting for 66.67% (20/30). Respiratory symptoms had a response rate of 72.00% (18/25), showing the most remarkable improvement. Meanwhile, extraocular symptoms were the least sensitive, with only 8.00% (2/25) showing efficacy. Thymoma (100.00% vs 50.00%, P=0.002) and a high concentration of AChR-Ab (37.37 nmol/L vs 25.4 nmol/L, P=0.039) were common in the early response group. Repeated measures showed significant changes in AChR-Ab and CD19 + B cells before and after TPE (all with P < 0.05). After treatment, the CD19 + B cells tended to decrease in the response group. Discussion: These results indicated that, for AChR-Ab positive generalized MG, TPE can quickly improve respiratory symptoms. Thymoma and a high concentration of AChR-Ab before TPE predict an early better response. Additionally, TPE may work by decreasing AChR-Ab levels and inducing immune regulation. Future prospective and randomized controlled studies are needed.

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Section: Discussionmentioning

confidence: 99%

Therapeutic Plasma Exchange in AChR-Ab Positive Generalized Myasthenia Gravis: A Real World Study About Its Early Response

Chen,

Feng,

et al. 2024

JIR

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“…Although no randomized, controlled trial (RCT) has been conducted to evaluate PE in the treatment of patients in myasthenic crisis, it still is an established treatment. [3][4][5] A usual course of treatment during PE is comprised of five exchanges over 1 to 2 weeks. Three to five litres of plasma is exchanged during each exchange.…”

Section: Discussionmentioning

confidence: 99%

Small Volume Plasma Exchange as an Alternative to Conventional Plasma Exchange and Intravenous Immunoglobulin for Myasthenic Crisis: A Case Report

et al. 2023

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Myasthenic crisis is a life-threatening condition. At times it manifests as the initial presentation of the underlying myasthenia gravis. Rapidly acting therapies for treatment of this condition are plasma exchange and intravenous immunoglobulin. We report a case of myasthenic crisis in a young female, presenting with respiratory failure and bulbar symptoms. She had significantly raised titres of anti-acetylcholine receptor antibody. She was treated with multiple sessions of small volume plasma exchange. This modification of conventional plasma exchange significantly reduces costs and is potentially an effective alternative to conventional plasma exchange and intravenous immunoglobulin in resource-poor settings.

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“…TPE reduces both the level of protective Ab and AChR Ab; additionally, it delays the need for immediate immunosuppressive therapy [ 180 ]. TPE seems an economically viable option for developing countries owing to its low cost and complexity [ 183 , 184 ]. This therapy has been found effective for MuSK MG patients too [ 185 ].…”

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

confidence: 99%

“…This therapy has been found effective for MuSK MG patients too [ 185 ]. Even a short-term TPE reduces the risk of ICU [ 186 ]; whereas regular TPE therapy is effective in improving quality of life and reducing the frequent need for immunosuppressants [ 187 ]. A clinical trial with an 8-year follow-up reported a safer and more efficacious profile of TPE sessions every 2-3 weeks for severe and moderate MG patients who were not unresponsive to immunosuppressive therapy [ 188 ].…”

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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Outcome of therapeutic plasma exchange in Myasthenia gravis patients

Cited by 4 publications

References 29 publications

Therapeutic Plasma Exchange in AChR-Ab Positive Generalized Myasthenia Gravis: A Real World Study About Its Early Response

Therapeutic Plasma Exchange in AChR-Ab Positive Generalized Myasthenia Gravis: A Real World Study About Its Early Response

Small Volume Plasma Exchange as an Alternative to Conventional Plasma Exchange and Intravenous Immunoglobulin for Myasthenic Crisis: A Case Report

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

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