Treatment of Severe Myasthenia Gravis with Protein A Immunoadsorption and Cyclophosphamide

Flachenecker, Peter; Taleghani, Behrouz Mansouri; Gold, Ralf; Grossmann, Ralf; Wiebecke, D; Toyka, Klaus V.

doi:10.1016/s0955-3886(97)00102-1

Cited by 20 publications

(11 citation statements)

References 15 publications

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“…47 A recent study comparing plasmapheresis and IVIg as maintenance therapies in JMG shows that both are effective, but there is a more consistent response rate in patients treated with plasmapheresis. 48 Immunoadsorption is an extracorporeal elimination therapy with selective antibody filtration and has shown good efficacy in adults, [49][50][51] in some children, 52,53 and in 1 patient in our study. An objective assessment of the effectiveness of this treatment requires further study in children, along with longer follow-up.…”

Section: Discussionmentioning

confidence: 74%

Clinical features and evolution of juvenile myasthenia gravis in a French cohort

et al. 2017

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Section: Discussionmentioning

confidence: 74%

Clinical features and evolution of juvenile myasthenia gravis in a French cohort

et al. 2017

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“…Traditional plasma exchange entails removal of the pathogenic antibodies (antinicotinic ACh receptor, anti-MUSK antibodies and antibodies to as yet to be characterized antigens) and other plasma components such as soluble adhesion molecules and cytokines [51], separation from other blood components and then supplementation with 5% human albumin and crystalloids or rarely fresh frozen plasma to maintain homeostasis. The procedure may be carried out by plasma filtration techniques, plasma separation and more recently by antigen-specific immunoadsorption techniques [52,53] that enable the return of non-pathogenic blood components to the patient. A standard course in myasthenia exacerbation entails 5 to 6 exchanges on alternating days utilizing 2 to 4 L per exchange [49,50].…”

Section: Plasma Exchangementioning

confidence: 99%

Myasthenic crisis: Guidelines for prevention and treatment

Jani‐Acsadi¹,

Lisak²

2007

Journal of the Neurological Sciences

114

124

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“…In order to increase the efficiency and selectivity of plasmapheresis, standard plasmapheresis techniques have been combined with (semi-)selective immunoadsorption to tryptophan-linked polyvinylalcohol gels or protein-A-columns. 29,30 These more selective procedures seem to be at least as effective as standard plasmapheresis. Because there is negligible adsorption of albumin with immunoadsorption columns, protein substitution is not required.…”

Section: Plasmapheresismentioning

confidence: 99%

Current and Future Standards in Treatment of Myasthenia Gravis

Gold

Schneider‐Gold

2008

Neurotherapeutics

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Summary: Myasthenia gravis (MG) is a prototypic antibodymediated neurological autoimmune disorder. Herein we characterize modern treatment algorithms that are adapted to disease severity, and introduce the current principles of escalating strategies for MG treatment. In non-thymoma patients younger than about 50 years of age and with generalized weakness, a complete early (but not urgent) thymectomy is considered as state-of-the-art on the basis of circumstantial evidence and expert opinion. In up to 10% of patients, MG is associated with a thymoma (i.e., is of paraneoplastic origin). The best surgical type of procedure is still under debate.Myasthenic crisis is best treated by plasmapheresis, mostly combined with immunoabsorption techniques. Intravenous immunoglobulins are a reasonable alternative, but a shortage in supplies and high prices limit their use. In generalized MG, a wide array of immunosuppressive treatments has been established, although not formally tested in double-blind, prospective trials. With regard to immunosuppression, azathioprine is still the standard baseline treatment, often combined with initial corticosteroids. In rare patients with an inborn hepatic enzyme deficiency of thiomethylation, azathioprine may be substituted by mycophenolate mofetil. Severe cases may benefit from combined immunosuppression with corticosteroids, cyclosporine A, and even with moderate doses of methotrexate or cyclophosphamide. Tacrolimus is under investigation.In refractory cases, immunoablation via high-dose cyclophosphamide followed by trophic factors such as granulocyte colony-stimulating factor has also been suggested. In the future we may face an increased use of novel, B-cell, or T-celldirected monoclonal antibodies.

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Treatment of Severe Myasthenia Gravis with Protein A Immunoadsorption and Cyclophosphamide

Cited by 20 publications

References 15 publications

Clinical features and evolution of juvenile myasthenia gravis in a French cohort

Clinical features and evolution of juvenile myasthenia gravis in a French cohort

Myasthenic crisis: Guidelines for prevention and treatment

Current and Future Standards in Treatment of Myasthenia Gravis

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