title: Intravenous immunoglobulin as treatment for myasthenia gravis: current evidence and outcomes.
abstract: We examined the current evidence for the efficacy of IV immunoglobulin (IVIG) in myasthenia gravis (MG) and the outcomes used to demonstrate this efficacy. There is class 1 evidence for the use of short-term IVIG in MG patients worsening MG and also good evidence for IVIG use in myasthenic crisis. For long-term maintenance therapy, controlled studies are lacking and the evidence is limited to class III retrospective studies. The clinical scales, serological, electrophysiological, and patient-reported quality of life outcomes with IVIG have been assessed. At this time, the quantitative myasthenia gravis score, a functional scale, remains the preferable outcome measure as it has demonstrated responsiveness in the clinical trial setting, but a scale incorporating patient-reported outcomes and the patients complaint of fatigue is likely to be preferable. The MG-composite is such a scale, but has measurement limitations that may reduce its sensitivity. Across trials, IVIG has generally been well tolerated.
authors.affiliation: Division of Neurology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, Ontario, M5A 4H9, Canada.
authors.forename: Majed
authors.initials: M
authors.lastname: Alabdali
authors.forename: Carolina
authors.initials: C
authors.lastname: Barnett
authors.forename: Hans
authors.initials: H
authors.lastname: Katzberg
authors.forename: Ari
authors.initials: A
authors.lastname: Breiner
authors.forename: Vera
authors.initials: V
authors.lastname: Bril
mesh_terms: D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D009157:Myasthenia Gravis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous
keywords: IVIG; myasthenia gravis; outcomes; response; treatment