title: Immunoadsorption versus plasma exchange versus combination for treatment of myasthenic deterioration.
abstract: OBJECTIVE
  The goal of this study was to analyze safety and assess the efficacy of standard plasma exchange (PE) compared with immunoadsorption (IA) alone, or an alternating combination of both in deteriorating myasthenia gravis (MG).
  
  
  METHODS
  A total of 72 patients with MG who had received PE procedures for treatment of severe deterioration were retrospectively analyzed. They received either five cycles of PE (1-1.5 plasma volumes), or five cycles of IA in line with plasma separation, or a sequential alternating procedure of one cycle of PE followed by two cycles of IA, which was repeated once or more if needed.
  
  
  RESULTS
  A total of 19 patients received PE, 24 patients IA, and 29 the alternating combination therapy. All groups were equally distributed by sex and mean MG score before treatment. The number of treatment cycles and days on therapy did not differ between the groups. Mean MG scores at discharge were 3.0 (PE), 1.8 (IA) and 1.6 (combination) (p = 0.028 for combination versus PE). Inpatient time was 30.7 days (PE), 22.3 days (IA) and 20.0 days in combination therapy (p < 0.05 for combination versus PE). Side effects such as allergic reactions or hypocoagulability were significantly more frequent in the PE group (37% in PE versus 4% in IA and 3.6% in the alternating combination, p < 0.05).
  
  
  CONCLUSIONS
  Semiselective IA in combination with PE, and to a lesser extent IA alone, was associated with a shorter hospital stay and more pronounced reduction of the MG score than PE.
authors.affiliation: Department of Neurology, University of Würzburg, Würzburg, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Schneider-Gold
authors.affiliation: Department of Neurology, University of Würzburg, Würzburg, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Krenzer
authors.affiliation: Transfusion Medicine, University of Würzburg, Würzburg, Germany.
authors.forename: Erdmute
authors.initials: E
authors.lastname: Klinker
authors.affiliation: Transfusion Medicine, University of Würzburg, Würzburg, Germany.
authors.forename: Behrouz
authors.initials: B
authors.lastname: Mansouri-Thalegani
authors.affiliation: Department of Neurology, University of Würzburg, Würzburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Müllges
authors.affiliation: Department of Neurology, University of Würzburg, Würzburg, Germany.
authors.forename: Klaus V
authors.initials: KV
authors.lastname: Toyka
authors.affiliation: Department of Neurology, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstr. 56, 44791 Bochum, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Gold
keywords: immunoadsorption; myasthenia gravis; myasthenic crisis; plasma exchange; therapy