Open AccessImmunoglobulin versus Plasmapheresis in treatment of Myasthenia Gravis: a systematic review
Author(s) -
Isabella Delfim de Carvalho,
Felipe Iankelevich Baracat,
Lucas Farina Lima
Publication year - 2021
Language(s) - English
Resource type - Conference proceedings
DOI - 10.5327/1516-3180.366
Subject(s) - medicine , thymectomy , myasthenia gravis , plasmapheresis , jadad scale , adverse effect , immunoadsorption , randomized controlled trial , clinical trial , antibody , surgery , pediatrics , immunology , cochrane library
Myasthenia Gravis (MG) is an autoimmune and neuromuscular disease. The treatment of immunomodulation consists of intravenous immunoglobulin (IVIg), immunoadsorption (IA), plasmapheresis (PLEX) or double filtration plasmapheresis (DFPP). This systematic review aims to compare therapy modalities in MG crisis. Methods: The studies were identified through research in electronic databases and analyzed individually to clarify their methodological quality (through the Jadad and Newcastle Ottawa scale). Clinical trials randomized or not, and retrospective studies were included. The review included 1,983 patients in nine studies, the result analysis groups were divided into: IVIg x PLEX in the crises; IVIg x PLEX in the pre-thymectomy treatment phase and IVIg x DFPP in the myasthenic crisis. The evaluated outcomes were clinical improvement, adverse effects and length of hospital stay. Results: Immunomodulatory therapy when applied prior to thymectomy was shown to be effective in reducing symptoms and post-thymectomy hospitalization, with IVIg slightly higher, while PLEX showed more side effects. Therapy during crises in both interventions proved to be effective after the 14th start of treatment, in addition to IVIg being slightly superior. Treatment with IVIg was also economically favorable, due to the lower need for hospitalizations. IVIg proved to be inferior to therapy with DFPP and IA, mainly in reducing the need for hospitalization. Conclusion: It is concluded that IVIg therapy is a good therapeutic option in cases of crisis and when available, therapies with DFPP and IA should be the choices, aiming at less complications.