Clinical evaluation of a staphylococcal protein A immunoadsorption system in the treatment of myasthenia gravis patients.
BACKGROUND
The role of plasma exchange is well established in the management of myasthenia gravis, an autoimmune disorder characterized by muscle weakness and caused by circulating IgG antibodies with specificity against the acetylcholine receptor. Plasma antibody removal by conventional means, however, is nonselective and uses replacement fluids (chiefly, albumin solution) derived from human plasma.


METHODS
The Canadian Apheresis Group undertook a study at two Canadian apheresis centers to clinically evaluate a staphylococcal protein A immunoadsorption system (EXCORIM) in myasthenia gravis patients.


RESULTS
The immunoadsorption system was safe and well tolerated. Ten of 12 patients had improvement in their neurologic status, as measured by a 20-point scoring system. The mean improvement in the weakness score was significant for the group (p = 0.0013).


CONCLUSIONS
Patients with myasthenia gravis respond to treatment with plasma immunoadsorption. Further studies are required for a cost-benefit analysis.
Division of Hematology, Vancouver Hospital and Health Sciences Centre, British Columbia, Canada.
W B
WB
Benny
D M
DM
Sutton
J
J
Oger
V
V
Bril
M J
MJ
McAteer
G
G
Rock
D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood; D002951:Citrates / Q000009:adverse effects; D005260:Female; D006400:Hematocrit; D006801:Humans; D007132:Immunoglobulin Isotypes / Q000097:blood; D007163:Immunosorbent Techniques / Q000009:adverse effects; D007164:Immunosorbents; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000628:therapy*; D009460:Neurologic Examination; D010951:Plasma Exchange; D011950:Receptors, Cholinergic / Q000276:immunology; D013205:Staphylococcal Protein A / Q000494:pharmacology*
D000906:Antibodies; D002951:Citrates; D007132:Immunoglobulin Isotypes; D007164:Immunosorbents; D011950:Receptors, Cholinergic; D013205:Staphylococcal Protein A