PMID- 38306763
OWN - NLM
STAT- MEDLINE
DCOM- 20240311
LR  - 20240311
IS  - 1532-2653 (Electronic)
IS  - 0967-5868 (Linking)
VI  - 121
DP  - 2024 Mar
TI  - Assessing the comparative efficacy of plasmapheresis and Intravenous 
      immunoglobulin in myasthenia gravis treatment: A systematic review and 
      meta-analysis.
PG  - 1-10
LID - S0967-5868(24)00025-0 [pii]
LID - 10.1016/j.jocn.2024.01.025 [doi]
AB  - BACKGROUND: Myasthenia gravis (MG) is an autoimmune neuromuscular disorder 
      characterized by muscle weakness, posing significant challenges to patients' 
      daily lives. Intravenous immunoglobulin (IVIG) and plasmapheresis are two 
      prominent immunomodulatory therapies used in MG management, but the choice 
      between them remains a clinical dilemma. This systematic review and meta-analysis 
      aim to evaluate the comparative efficacy of IVIG versus plasmapheresis in MG 
      management. METHODS: We adhered to PRISMA guidelines and prospectively registered 
      the review protocol in PROSPERO. Systematic search across electronic databases 
      identified 14 studies meeting inclusion criteria. Data from these studies were 
      extracted, and assessed risk of bias. Primary outcomes included clinical 
      efficacy, while secondary outcomes encompassed hospitalization, ventilation, 
      antibody titers, and treatment-related complications. Statistical analysis was 
      conducted using R software. RESULTS: The pooled results indicated that patients 
      receiving plasmapheresis had higher odds of any improvement in MG symptoms 
      compared to IVIG. However, change in severity scores did not significantly differ 
      between the two treatments. Hospitalization durations were similar, but 
      IVIG-treated patients tended to have shorter stays. Antibody titers, particularly 
      anti-MUSK antibodies, favored plasmapheresis treatment. Complication rates were 
      comparable between two groups. However, severe complications were more common in 
      plasmapheresis. CONCLUSION: This comprehensive analysis suggests that 
      plasmapheresis may offer superior short-term symptom improvement in MG compared 
      to IVIG, while IVIG may lead to shorter hospital stays and lower complication 
      rates. The choice between these treatments should be tailored to individual 
      patient needs and disease characteristics. Further research is needed to explore 
      long-term outcomes and mortality rates in MG management.
CI  - Copyright (c) 2024 Elsevier Ltd. All rights reserved.
FAU - Ghimire, Anup
AU  - Ghimire A
AD  - Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, 
      Kathmandu, Nepal. Electronic address: anup2056@iom.edu.np.
FAU - Kunwar, Bijay
AU  - Kunwar B
AD  - Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, 
      Kathmandu, Nepal.
FAU - Aryal, Binay
AU  - Aryal B
AD  - Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, 
      Kathmandu, Nepal.
FAU - Gaire, Arjun
AU  - Gaire A
AD  - Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, 
      Kathmandu, Nepal.
FAU - Bist, Anil
AU  - Bist A
AD  - Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, 
      Kathmandu, Nepal.
FAU - Shah, Bilash
AU  - Shah B
AD  - Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, 
      Kathmandu, Nepal.
FAU - Mainali, Atul
AU  - Mainali A
AD  - Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, 
      Kathmandu, Nepal.
FAU - Ghimire, Bikal
AU  - Ghimire B
AD  - Kantipur Dental College Teaching Hospital &amp, Research Center, Basundhara, 
      Kathmandu, Nepal.
FAU - Gajurel, Bikram Prasad
AU  - Gajurel BP
AD  - Department of Neurology, Maharajgunj Medical Campus, Tribhuvan University, 
      Institute of Medicine, Kathmandu, Nepal.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20240201
PL  - Scotland
TA  - J Clin Neurosci
JT  - Journal of clinical neuroscience : official journal of the Neurosurgical Society 
      of Australasia
JID - 9433352
RN  - 0 (Immunoglobulins, Intravenous)
SB  - IM
MH  - Humans
MH  - *Immunoglobulins, Intravenous/therapeutic use
MH  - Plasmapheresis/methods
MH  - *Myasthenia Gravis/drug therapy
MH  - Treatment Outcome
MH  - Length of Stay
OTO - NOTNLM
OT  - Efficacy
OT  - Intravenous Immunoglobulin
OT  - Meta-analysis
OT  - Myasthenia Gravis
OT  - Plasma exchange
OT  - Plasmapheresis
COIS- Declaration of competing interest The authors declare that they have no known 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this paper.
EDAT- 2024/02/03 00:42
MHDA- 2024/03/11 06:43
CRDT- 2024/02/02 18:03
PHST- 2023/10/07 00:00 [received]
PHST- 2023/11/28 00:00 [revised]
PHST- 2024/01/29 00:00 [accepted]
PHST- 2024/03/11 06:43 [medline]
PHST- 2024/02/03 00:42 [pubmed]
PHST- 2024/02/02 18:03 [entrez]
AID - S0967-5868(24)00025-0 [pii]
AID - 10.1016/j.jocn.2024.01.025 [doi]
PST - ppublish
SO  - J Clin Neurosci. 2024 Mar;121:1-10. doi: 10.1016/j.jocn.2024.01.025. Epub 2024 
      Feb 1.