Comparative Evaluation of Intravenous Immunoglobulin and Plasmapheresis in the Treatment of Generalized Myasthenia
For the treatment of severe manifestations of myasthenia, in addition to anticholinesterase drugs, corticosteroids and immunosuppressants, plasmapheresis (PF) and intravenous immunoglobulin (IVIG) are used. We analyzed the result of the treatment of myasthenia in 73 people using PF and in 19 patients using IVIG. According to the data obtained, PF and IVIG are effective methods for treating the severe manifestations of myasthenia. A significant decrease in the symptoms of the disease was observed in 58 (79.5%) patients after the course of PF and in 17 (89.5%) patients after the course of IVIG. Nevertheless, PF and IVIG have comparable efficacy (p=0.372) and the duration of preservation of the achieved therapeutic effect (p=0.063). However, the therapeutic effect after a course of IVIG develops earlier in comparison with PF (p=0.007), and serious adverse events are more often observed when using the PF method than when using IVIG. Despite the equal effectiveness of both methods of treatment, in the absence of a therapeutic effect from the PF procedure, IVIG may be an alternative method of treatment for this category of patients. When analyzing a psychological discomfort associated with plasmapheresis, 14 (19.2%) of those surveyed reported stress before the procedure. Only one (5.2%) patient claimed discomfort before intravenous immunoglobulin procedure. Choice of PF or IVIG is made taking into consideration the coexisting condition, and out of the equipment capability of the health care facility.