Plasmapheresis in Treatment of Myasthenia Gravis

Abstract

Treatment of myasthenia gravis is still a rather difficult task, since there is no single tactic to use different drugs (corticosteroids, rituximab, immunoglobulins), especially since it is associated with a number of side effects. They are not able to remove the accumulating autoantibodies and immune complexes, the large size of which does not allow them to be excreted by the kidneys as well. Special problems of treatment arise when myasthenic crises develop associated with respiratory failure requiring artificial lungs ventilation. Plasmapheresis can help to solve this for it is possible to remove antibodies and other pathological metabolites. In addition, regular plasmapheresis is able not only to prevent exacerbations but also to reduce doses of the maintenance therapy with less risk of their side effects, which is confirmed by our own experience.

Our Clinical Experience in the Treatment of Myasthenia Gravis Acute Exacerbations with a Novel Nanomembrane-Based Therapeutic Plasma Exchange Technology

“…Our primary outcomes ( Table 2 ) support the advantages of TPE for superior ventilator status in terms of less intubation with IMV, more NIV, less tracheotomy, and quick response rate in MC reported by others [ 14 , 20 , 21 , 22 , 23 , 24 , 25 ]. Our secondary outcomes ( Table 4 ) support the role of TPE for early extubation (≤7 days) as well as the role of NIV for decreasing ventilation duration (≤7 days) reported by others [ 9 , 26 ].…”

“…Therefore, there is an unmet need for targeted immunomodulatory therapies, which has resulted in an ongoing campaign to develop safer and more effective treatments for MG [ 11 ]. The technological advances for a direct removal of auto-antibodies in patients with MG, such as immunoabsorption [ 12 ], double-filtration plasmapheresis [ 13 ], and nanomembrane-based TPE technology [ 14 ], pose new challenges and perspectives in this context.…”

Therapeutic Plasma Exchange in Certain Immune-Mediated Neurological Disorders: Focus on a Novel Nanomembrane-Based Technology

“…Covered in the last review on blood apheresis technologies [22] Membrane with silicon dioxide nanoparticles Experimental Hemodialysis [23] Membrane with ferric oxide nanoparticles Experimental Hemodialysis [24] Membrane with multi-walled carbon nanotubes Experimental Hemodialysis [25] Membrane with graphene oxide nanoparticles Experimental Hemodialysis [26,27] Not covered in the last review on blood apheresis technologies [22] Membrane with nanoscale pores made of Lavsan film irradiated by accelerated in a collider charged argon particles Clinical TPE [9,[28][29][30][31][32][33]…”

Nanomembrane-Based Apheresis: A Simple and Safe Procedure for Preventing Cardiovascular Complications in Metabolic Syndrome

“…The nanomembrane is made of Lavsan film irradiated by accelerated charged argon particles in a collider, creating pores with diameters of 30-50 nm. This allows it to filter molecules with a weight of less than 40 kDa [21][22][23]. In nanomembrane-based LVPE, the most frequently used replacement fluid is saline solution, which has no side effects even when 25-30% of the circulated plasma is separated [24].…”