Therapeutic Apheresis in Myasthenia Gravis Patients: A Six Year Follow‐Up

Abstract

Six years ago 4 patients suffering from myasthenia gravis (MG) types C and E according to Compston with failed drug therapy were initially treated 3 times (1 patient, a total of 11 times) by protein A immunoadsorption (Immunosorba, Excorim AB, Lund, Sweden). No further immunoadsorption treatments have been carried out. In addition, 3 patients were given a thymectomy. The present status of the patients was checked. We could see a beneficial effect in all MG patients. The patients are fit for work; each has an improved Besinger index. The patients were used as their own controls. A higher anti‐AChRAb level 6 years after protein A immunoadsorption than at the beginning was seen in all patients, combined with less serious MG. In addition, their immunomodulation could be induced as seen in lymphocyte and inflammatory protein changes during the first 36 days after beginning immunoadsorption treatment. A larger population has to be investigated to verify these results.

Immunoadsorption in patients with autoimmune ion channel disorders of the peripheral nervous system

“…All patients were treated for at least one year. We observed clinical improvement in five of them (two patients that were wheelchair-bound regained walking) [23]. Clinical improvement was correlated with neurophysiological findings (i.e.…”

Removal of Pathogenic Autoantibodies by Immunoadsorption

“…Apart from these FDA‐approved indications, SPA‐based immunoadsorption has been tried in several other autoimmune entities. There are data supporting a possible beneficial effect in patients with diseases such as Goodpasture syndrome,19 Wegener's granulomatosis,9 thrombotic thrombocytopenic purpura/hemolytic uremic syndrome,20 and myasthenia gravis 21‐23. In SLE, Immunosorba has induced complete elimination of circulating immune complexes and normalization of antibodies against double‐stranded DNA (dsDNA), with concomitant amelioration of inflammation 7,24.…”

“…There are data supporting a possible beneficial effect in patients with diseases such as Goodpasture syndrome, 19 Wegener's granulomatosis, 9 thrombotic thrombocytopenic purpura/hemolytic uremic syndrome, 20 and myasthenia gravis. [21][22][23] In SLE, Immunosorba has induced complete elimination of circulating immune complexes and normalization of antibodies against double-stranded DNA (dsDNA), with concomitant amelioration of inflammation. 7,24 Acute vascular rejection of transplanted kidneys, which is mediated by anti-HLA antibodies also appears to respond well to SPA-based extracorporeal immunoadsorption.…”

Background and Indications for Protein A‐Based Extracorporeal Immunoadsorption

“…It is, however, not conceivable where to place Immunosorba among alternative treatment possibilities. It may have certain advantages when patients are treated chronically, and the possible reuse of columns generates advantages in costs, or when antibody removal has to be achieved very rapidly (87)(88)(89)(90)(91)(92). Mentionable in this context is the successful application of off-line plasma perfusion over Prosorba columns in paraneoplastic neurologic syndromes (93)(94)(95).…”