title: Clinical trial of plasma exchange and high-dose intravenous immunoglobulin in myasthenia gravis. Myasthenia Gravis Clinical Study Group.
abstract: We have conducted a trial to randomly assess the efficacy and tolerance of intravenous immunoglobulin (i.v.Ig) or plasma exchange (PE) in myasthenia gravis (MG) exacerbation and to compare two doses of i.v.Ig. Eighty-seven patients with MG exacerbation were randomized to receive either three PE (n = 41), or i.v.Ig (n = 46) 0.4 gm/kg daily further allocated to 3 (n = 23) or 5 days (n = 23). The main end point was the variation of a myasthenic muscular score (MSS) between randomization and day 15. The MSS variation was similar in both groups (median value, +18 in the PE group and +15.5 in the i.v.Ig group, p = 0.65). Similar efficacy, although slightly reduced in the 5-day group was observed with both i.v.Ig schedules. The tolerance of i.v.Ig was better than that of PE with a total of 14 side effects observed in 9 patients, 8 in the PE group and 1 in the i.v.Ig group (p = 0.01). Although our trial failed to show a pronounced difference in the efficacy of both treatments, it exhibited a very limited risk for i.v.Ig. i.v.Ig is an alternative for the treatment of myasthenic crisis. The small sample sizes in our trial, however, could explain why a difference in efficacy was not observed. Further studies are needed to compare PE with i.v.Ig and to determine the optimal dosage of i.v.Ig.
authors.affiliation: Service de Réanimation, Hôpital Raymond Poincaré, Garches, France.
authors.forename: P
authors.initials: P
authors.lastname: Gajdos
authors.forename: S
authors.initials: S
authors.lastname: Chevret
authors.forename: B
authors.initials: B
authors.lastname: Clair
authors.forename: C
authors.initials: C
authors.lastname: Tranchant
authors.forename: C
authors.initials: C
authors.lastname: Chastang
mesh_terms: D000328:Adult; D000368:Aged; D000906:Antibodies / Q000032:analysis; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000503:physiopathology; D009157:Myasthenia Gravis / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D010951:Plasma Exchange; D011950:Receptors, Cholinergic / Q000276:immunology
chemical_list: D000906:Antibodies; D016756:Immunoglobulins, Intravenous; D011950:Receptors, Cholinergic