title: Treatment of myasthenia gravis exacerbation with intravenous immunoglobulin: a randomized double-blind clinical trial.
abstract: BACKGROUND
  The optimal dose of intravenous immunoglobulin (IVIG) in acute exacerbation of myasthenia gravis remains unknown. Increasing the treatment duration might provide added efficacy.
  
  
  OBJECTIVE
  To determine the optimal dose of IVIG for treating myasthenia gravis exacerbation.
  
  
  METHODS
  Randomized double-blind placebo-controlled multicenter trial designed to demonstrate superiority of the 2 g/kg dose over the 1 g/kg dose of IVIG, conducted between November 13, 1996, and October 26, 2002.
  
  
  METHODS
  One hundred seventy-three patients aged 15 to 85 years with acute exacerbation of myasthenia gravis.
  
  
  METHODS
  Participants were randomly assigned to receive 1 g/kg of IVIG on day 1 and placebo on day 2 (group 1) vs 1 g/kg of IVIG on 2 consecutive days (group 2).
  
  
  METHODS
  Improvement in the myasthenic muscular score after 2 weeks.
  
  
  RESULTS
  The mean improvements in the myasthenic muscular scores after 2 weeks were 15.49 points (95% confidence interval, 12.09-18.90 points) in group 1 and 19.33 points (95% confidence interval, 15.82-22.85 points) in group 2. However, the difference between the 2 groups was not significant (effect size, 3.84 [95% confidence interval, -1.03 to 8.71]; P = .12).
  
  
  CONCLUSIONS
  This trial found no significant superiority of 2 g/kg over 1 g/kg of IVIG in the treatment of myasthenia gravis exacerbation.
authors.affiliation: Medical Intensive Care Unit, Raymond Poincaré Teaching Hospital, Assistance publique-Hôpitaux de Paris, Garches, France. mp.gajdos@9online.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Gajdos
authors.forename: Christine
authors.initials: C
authors.lastname: Tranchant
authors.forename: Bernard
authors.initials: B
authors.lastname: Clair
authors.forename: Francis
authors.initials: F
authors.lastname: Bolgert
authors.forename: Bruno
authors.initials: B
authors.lastname: Eymard
authors.forename: Tanya
authors.initials: T
authors.lastname: Stojkovic
authors.forename: Shahram
authors.initials: S
authors.lastname: Attarian
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000628:therapy*; D009460:Neurologic Examination; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous