Comparison between double-filtration plasmapheresis and immunoadsorption plasmapheresis in the treatment of patients with myasthenia gravis |
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Authors: | Jiann-Horng Yeh Hou-Chang Chiu |
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Institution: | (1) Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, 95, Wen Chang Road, Shih-Lin, Taipei, Taiwan, TW |
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Abstract: | Two techniques for plasmapheresis are used in the treatment of myasthenia gravis (MG): immunoadsorption (IA) and double filtration
(DR). This controlled study evaluated the differences between these techniques in clinical effects and serological changes.
Five patients with generalized MG (clinical states IIb and III) were enrolled; each patient received IA and DF plasmapheresis
on separate occasions. Immunosorba TR-350 with an affinity to acetylcholine receptor antibodies (AchRAb) was used for IA,
while Evaflux 4A was used as the plasma fractionator for DF. Each course of treatment consisted of five sessions of apheresis.
MG score, titers of AchRAb, immunoglobulins (IG), and plasma biochemistry were assessed by blinded examiners before and immediately
after the entire course of treatment. Both treatments effectively ameliorated symptoms of MG. There were no significant changes
in MG score between the two groups (IA vs. DF: 2.2 vs. 2.6, P>0.5). IA had a higher clearance rate of AchRAb than DF (66 % vs. 54 %, P<0.05), while DF removed more IgA (72 % vs. 21 %, P< 0.05) and IgM (89 % vs. 57 %, P<0.01) than did IA. Although IA removed AchRAb more effectively than DF, the clinical effects between these two treatments
were similar. The titers of AchRAb cannot reflect the clinical severity. Some circulating factors other than AchRAb may contribute
to the pathogenesis of MG.
Received: 10 September 1999, Received in revised form: 7 February 2000, Accepted: 24 February 2000 |
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Keywords: | Double filtration plasmapheresis Immunoadsorption plasmapheresis Plasma exchange Myasthenia gravis Acetylcholine receptor antibody |
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