The Experts below are selected from a list of 261 Experts worldwide ranked by ideXlab platform
K Toyka - One of the best experts on this subject based on the ideXlab platform.
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Intravenous immunoglobulin for Myasthenia gravis.
The Cochrane database of systematic reviews, 2020Co-Authors: P Gajdos, S Chevret, K ToykaAbstract:Myasthenia gravis is an autoimmune disease. In up to 90 per cent of cases IgG autoantibodies to the nicotinic acetylcholine receptor are detectable which mediate the neuromuscular transmission disorder. As with other autoimmune diseases, patients would be expected to benefit from intravenous immunoglobulin. Case series and two randomised controlled trials suggest that intravenous immunoglobulin may be beneficial. The objective of this review is to examine the efficacy of intravenous immunoglobulin for treating exacerbations of Myasthenia gravis or for chronic Myasthenia gravis. We searched the Cochrane Neuromuscular Disease Group trials register (21 July 2002) and MEDLINE (January 1966 to July 2002) using 'Myasthenia gravis' and 'intravenous immunoglobulin' as the search terms. All randomised or quasi-randomised trials in which intravenous immunoglobulin was compared with no treatment, placebo or plasma exchange, in people with Myasthenia gravis who were diagnosed by an internationally accepted definition. One author extracted the data and the two others checked these data and the source from which they were derived. For methodological reasons, no formal meta-analysis was performed. We identified four randomised controlled trials (147 participants in total), all investigating short-term benefit. In the first study of 87 people with Myasthenia gravis exacerbation, comparing intravenous immunoglobulin and plasma exchange, there was no statistically significant difference between the efficacy of the two treatments after two weeks. In the second study 12 people with moderate or severe Myasthenia gravis were treated in a cross-over design trial with intravenous immunoglobulin or plasma exchange: no statistically significant difference in the efficacy of the two treatments was found after four weeks. In the third study 15 people with mild or moderate Myasthenia gravis received intravenous immunoglobulin or a placebo: no significant difference in efficacy of intravenous immunoglobulin or placebo was found six weeks after treatment. The last study, which included 33 people with moderate exacerbations of Myasthenia gravis, compared intravenous immunoglobulin and methylprednisolone and showed no statistically significant difference in the efficacy of the two treatments. One randomised controlled trial did not show a significant difference between intravenous immunoglobulin and plasma exchange for treatment of severe exacerbations of Myasthenia gravis. There is no evidence from randomised controlled trials to determine whether intravenous immunoglobulin for moderate or severe Myasthenia gravis improves functional outcome or has a sparing effect on steroid dosage, nor is there sufficient evidence to favour intravenous immunoglobulin over steroids in moderate exacerbations. Further randomised controlled trials are needed.
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intravenous immunoglobulin for Myasthenia gravis
Cochrane Database of Systematic Reviews, 2012Co-Authors: P Gajdos, S Chevret, K ToykaAbstract:Background Myasthenia gravis is an autoimmune disease in which autoantibodies interfere with neuromuscular transmission. As with other autoimmune diseases, people with Myasthenia gravis would be expected to benefit from intravenous immunoglobulin (IVIg). This is an update of a review first published in 2003 and last updated in 2007. Objectives To examine the efficacy of IVIg for treating exacerbations of Myasthenia gravis or for chronic Myasthenia gravis. Search methods We searched the Cochrane Neuromuscular Disease Group Specialized Register (11 October 2011), CENTRAL (2011, Issue 3), MEDLINE (January 1966 to September 2011) and EMBASE (January 1980 to September 2011) using 'Myasthenia gravis' and 'intravenous immunoglobulin' as the search terms. Selection criteria All randomised controlled trials (RCTs) or quasi-RCTs in which IVIg was compared with no treatment, placebo or plasma exchange, in people with Myasthenia gravis. Data collection and analysis One review author extracted the data and two others checked these data. For methodological reasons, no formal meta-analysis was performed. Main results We identified seven RCTs. These trials differ in inclusion criteria, comparison with alternative treatment and outcomes. In a trial comparing IVIg with placebo, including 51 participants with Myasthenia gravis worsening, the mean difference (MD) in quantitative Myasthenia gravis score (QMGS) (MD 95% CI) after 14 days was: -1.60 (95% CI - 3.23 to 0.03) this result being borderline statistically significant in favour of IVIg. In an unblinded study of 87 participants with exacerbation comparing IVIg and plasma exchange there was no difference in myasthenic muscle score (MMS) after 15 days (MD -1.00; 95% CI -7.72 to 5.72). In a study of 84 participants with worsening Myasthenia gravis there was no difference in change in QMGS 14 days after IVIg or plasma exchange (MD -1.50; 95% CI -3.43 to 0.43). In a study of 12 participants with moderate or severe Myasthenia gravis, which was at high risk of bias from skewed allocation, the mean fall in QMGS both for IVIg and plasma exchange after four weeks was significant (P < 0.05). A study with 15 participants with mild or moderate Myasthenia gravis found no difference in change in QMGS 42 days after IVIg or placebo (MD 1.60; 95% CI -1.92 to 5.12). A study included 33 participants with moderate exacerbations of Myasthenia gravis and showed no difference in change in QMGS 14 days after IVIg or methylprednisolone (MD -0.42; 95% CI -1.20 to 0.36). All these three smaller studies were underpowered. The last trial, including 168 people with exacerbations, showed no evidence of superiority of IVIg 2 g/kg over IVIg 1 g/kg on the change of MMS after 15 days (MD 3.84; 95% CI -0.98 to 8.66). Adverse events due to IVIg were moderate (fever, nausea, headache), self-limiting and subjectively less severe than with plasma exchange (although, given the available data, no statistical comparison was possible). Other than where specific limitations are mentioned the trials were generally at low risk of bias. Authors' conclusions In exacerbation of Myasthenia gravis, one RCT of IVIg versus placebo showed some evidence of the efficacy of IVIg and two did not show a significant difference between IVIg and plasma exchange. Another showed no significant difference in efficacy between 1 g/kg and 2 g/kg of IVIg. A further, but underpowered, trial showed no significant difference between IVIg and oral methylprednisolone. In chronic Myasthenia gravis, there is insufficient evidence from RCTs to determine whether IVIg is efficacious.
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Intravenous immunoglobulin for Myasthenia gravis.
The Cochrane database of systematic reviews, 2008Co-Authors: P Gajdos, S Chevret, K ToykaAbstract:Myasthenia gravis is an autoimmune disease in which autoantibodies interfere with neuromuscular transmission. As with other autoimmune diseases, people with Myasthenia gravis would be expected to benefit from intravenous immunoglobulin (IVIg). The objective of this review was to examine the efficacy of intravenous immunoglobulin for treating exacerbations of Myasthenia gravis or for chronic Myasthenia gravis. We searched the Cochrane Neuromuscular Disease GroupTrials Register (April 2007) and MEDLINE (January 1966 to May 2007) using 'Myasthenia gravis' and 'intravenous immunoglobulin' as the search terms. We included all randomised or quasi-randomised trials in which intravenous immunoglobulin was compared with no treatment, placebo or plasma exchange, in people with Myasthenia gravis. One review author extracted the data and two others checked these data and the source from which they were derived. For methodological reasons, no formal meta-analysis was performed. We identified six randomised controlled trials, all of which investigated short-term benefit. A trial of IVIg compared with placebo including 51 patients provided evidence for the effectiveness of IVIg in Myasthenia gravis worsening. A study of 87 participants with exacerbation found no statistically significant difference between immunoglobulin and plasma exchange after two weeks. A study of 12 participants with moderate or severe Myasthenia gravis treated in a crossover design trial found no statistically significant difference in the efficacy of immunoglobulin and plasma exchange after four weeks. A study with 15 participants with mild or moderate Myasthenia gravis found no statistically significant difference in efficacy of IVIg and placebo after six weeks. A study included 33 participants with moderate exacerbations of Myasthenia gravis and showed no statistically significant difference in the efficacy of IVIg and methylprednisolone. The last trial including 173 people with Myasthenia gravis exacerbations, showed no superiority of IVIg 1 g/kg on two consecutive days over IVIg 1 g/kg on a single day. In exacerbation of Myasthenia gravis, one randomised controlled trial of IVIg versus placebo demonstrated the efficacy of IVIg and another did not show a significant difference between IVIg and plasma exchange. Another showed no significant difference in efficacy between 1 g/kg and 2 g/kg of IVIg. A further, but underpowered, trial showed no significant difference between IVIg and oral methylprednisolone. In chronic Myasthenia gravis, there is insufficient evidence from randomised trials to determine whether IVIg is efficacious. More research is needed to determine whether IVIg reduces the need for corticosteroids as suggested by two case series.
P Gajdos - One of the best experts on this subject based on the ideXlab platform.
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Intravenous immunoglobulin for Myasthenia gravis.
The Cochrane database of systematic reviews, 2020Co-Authors: P Gajdos, S Chevret, K ToykaAbstract:Myasthenia gravis is an autoimmune disease. In up to 90 per cent of cases IgG autoantibodies to the nicotinic acetylcholine receptor are detectable which mediate the neuromuscular transmission disorder. As with other autoimmune diseases, patients would be expected to benefit from intravenous immunoglobulin. Case series and two randomised controlled trials suggest that intravenous immunoglobulin may be beneficial. The objective of this review is to examine the efficacy of intravenous immunoglobulin for treating exacerbations of Myasthenia gravis or for chronic Myasthenia gravis. We searched the Cochrane Neuromuscular Disease Group trials register (21 July 2002) and MEDLINE (January 1966 to July 2002) using 'Myasthenia gravis' and 'intravenous immunoglobulin' as the search terms. All randomised or quasi-randomised trials in which intravenous immunoglobulin was compared with no treatment, placebo or plasma exchange, in people with Myasthenia gravis who were diagnosed by an internationally accepted definition. One author extracted the data and the two others checked these data and the source from which they were derived. For methodological reasons, no formal meta-analysis was performed. We identified four randomised controlled trials (147 participants in total), all investigating short-term benefit. In the first study of 87 people with Myasthenia gravis exacerbation, comparing intravenous immunoglobulin and plasma exchange, there was no statistically significant difference between the efficacy of the two treatments after two weeks. In the second study 12 people with moderate or severe Myasthenia gravis were treated in a cross-over design trial with intravenous immunoglobulin or plasma exchange: no statistically significant difference in the efficacy of the two treatments was found after four weeks. In the third study 15 people with mild or moderate Myasthenia gravis received intravenous immunoglobulin or a placebo: no significant difference in efficacy of intravenous immunoglobulin or placebo was found six weeks after treatment. The last study, which included 33 people with moderate exacerbations of Myasthenia gravis, compared intravenous immunoglobulin and methylprednisolone and showed no statistically significant difference in the efficacy of the two treatments. One randomised controlled trial did not show a significant difference between intravenous immunoglobulin and plasma exchange for treatment of severe exacerbations of Myasthenia gravis. There is no evidence from randomised controlled trials to determine whether intravenous immunoglobulin for moderate or severe Myasthenia gravis improves functional outcome or has a sparing effect on steroid dosage, nor is there sufficient evidence to favour intravenous immunoglobulin over steroids in moderate exacerbations. Further randomised controlled trials are needed.
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intravenous immunoglobulin for Myasthenia gravis
Cochrane Database of Systematic Reviews, 2012Co-Authors: P Gajdos, S Chevret, K ToykaAbstract:Background Myasthenia gravis is an autoimmune disease in which autoantibodies interfere with neuromuscular transmission. As with other autoimmune diseases, people with Myasthenia gravis would be expected to benefit from intravenous immunoglobulin (IVIg). This is an update of a review first published in 2003 and last updated in 2007. Objectives To examine the efficacy of IVIg for treating exacerbations of Myasthenia gravis or for chronic Myasthenia gravis. Search methods We searched the Cochrane Neuromuscular Disease Group Specialized Register (11 October 2011), CENTRAL (2011, Issue 3), MEDLINE (January 1966 to September 2011) and EMBASE (January 1980 to September 2011) using 'Myasthenia gravis' and 'intravenous immunoglobulin' as the search terms. Selection criteria All randomised controlled trials (RCTs) or quasi-RCTs in which IVIg was compared with no treatment, placebo or plasma exchange, in people with Myasthenia gravis. Data collection and analysis One review author extracted the data and two others checked these data. For methodological reasons, no formal meta-analysis was performed. Main results We identified seven RCTs. These trials differ in inclusion criteria, comparison with alternative treatment and outcomes. In a trial comparing IVIg with placebo, including 51 participants with Myasthenia gravis worsening, the mean difference (MD) in quantitative Myasthenia gravis score (QMGS) (MD 95% CI) after 14 days was: -1.60 (95% CI - 3.23 to 0.03) this result being borderline statistically significant in favour of IVIg. In an unblinded study of 87 participants with exacerbation comparing IVIg and plasma exchange there was no difference in myasthenic muscle score (MMS) after 15 days (MD -1.00; 95% CI -7.72 to 5.72). In a study of 84 participants with worsening Myasthenia gravis there was no difference in change in QMGS 14 days after IVIg or plasma exchange (MD -1.50; 95% CI -3.43 to 0.43). In a study of 12 participants with moderate or severe Myasthenia gravis, which was at high risk of bias from skewed allocation, the mean fall in QMGS both for IVIg and plasma exchange after four weeks was significant (P < 0.05). A study with 15 participants with mild or moderate Myasthenia gravis found no difference in change in QMGS 42 days after IVIg or placebo (MD 1.60; 95% CI -1.92 to 5.12). A study included 33 participants with moderate exacerbations of Myasthenia gravis and showed no difference in change in QMGS 14 days after IVIg or methylprednisolone (MD -0.42; 95% CI -1.20 to 0.36). All these three smaller studies were underpowered. The last trial, including 168 people with exacerbations, showed no evidence of superiority of IVIg 2 g/kg over IVIg 1 g/kg on the change of MMS after 15 days (MD 3.84; 95% CI -0.98 to 8.66). Adverse events due to IVIg were moderate (fever, nausea, headache), self-limiting and subjectively less severe than with plasma exchange (although, given the available data, no statistical comparison was possible). Other than where specific limitations are mentioned the trials were generally at low risk of bias. Authors' conclusions In exacerbation of Myasthenia gravis, one RCT of IVIg versus placebo showed some evidence of the efficacy of IVIg and two did not show a significant difference between IVIg and plasma exchange. Another showed no significant difference in efficacy between 1 g/kg and 2 g/kg of IVIg. A further, but underpowered, trial showed no significant difference between IVIg and oral methylprednisolone. In chronic Myasthenia gravis, there is insufficient evidence from RCTs to determine whether IVIg is efficacious.
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Intravenous immunoglobulin for Myasthenia gravis.
The Cochrane database of systematic reviews, 2008Co-Authors: P Gajdos, S Chevret, K ToykaAbstract:Myasthenia gravis is an autoimmune disease in which autoantibodies interfere with neuromuscular transmission. As with other autoimmune diseases, people with Myasthenia gravis would be expected to benefit from intravenous immunoglobulin (IVIg). The objective of this review was to examine the efficacy of intravenous immunoglobulin for treating exacerbations of Myasthenia gravis or for chronic Myasthenia gravis. We searched the Cochrane Neuromuscular Disease GroupTrials Register (April 2007) and MEDLINE (January 1966 to May 2007) using 'Myasthenia gravis' and 'intravenous immunoglobulin' as the search terms. We included all randomised or quasi-randomised trials in which intravenous immunoglobulin was compared with no treatment, placebo or plasma exchange, in people with Myasthenia gravis. One review author extracted the data and two others checked these data and the source from which they were derived. For methodological reasons, no formal meta-analysis was performed. We identified six randomised controlled trials, all of which investigated short-term benefit. A trial of IVIg compared with placebo including 51 patients provided evidence for the effectiveness of IVIg in Myasthenia gravis worsening. A study of 87 participants with exacerbation found no statistically significant difference between immunoglobulin and plasma exchange after two weeks. A study of 12 participants with moderate or severe Myasthenia gravis treated in a crossover design trial found no statistically significant difference in the efficacy of immunoglobulin and plasma exchange after four weeks. A study with 15 participants with mild or moderate Myasthenia gravis found no statistically significant difference in efficacy of IVIg and placebo after six weeks. A study included 33 participants with moderate exacerbations of Myasthenia gravis and showed no statistically significant difference in the efficacy of IVIg and methylprednisolone. The last trial including 173 people with Myasthenia gravis exacerbations, showed no superiority of IVIg 1 g/kg on two consecutive days over IVIg 1 g/kg on a single day. In exacerbation of Myasthenia gravis, one randomised controlled trial of IVIg versus placebo demonstrated the efficacy of IVIg and another did not show a significant difference between IVIg and plasma exchange. Another showed no significant difference in efficacy between 1 g/kg and 2 g/kg of IVIg. A further, but underpowered, trial showed no significant difference between IVIg and oral methylprednisolone. In chronic Myasthenia gravis, there is insufficient evidence from randomised trials to determine whether IVIg is efficacious. More research is needed to determine whether IVIg reduces the need for corticosteroids as suggested by two case series.
Robert M Pascuzzi - One of the best experts on this subject based on the ideXlab platform.
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thymoma Myasthenia gravis and other paraneoplastic syndromes
Hematology-oncology Clinics of North America, 2008Co-Authors: Laura M Tormoehlen, Robert M PascuzziAbstract:The relationship between Myasthenia gravis and thymic pathology, including thymoma, is well known. Approximately 10% to 15% of patients who have Myasthenia gravis are observed to have a thymoma. Myasthenia gravis may be considered as the most common of the paraneoplastic syndromes in patients who have thymoma. This article summarizes the clinical aspects of Myasthenia gravis, followed by a review of the less often recognized paraneoplastic disorders noted to occur in patients who have thymoma.
S Chevret - One of the best experts on this subject based on the ideXlab platform.
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Intravenous immunoglobulin for Myasthenia gravis.
The Cochrane database of systematic reviews, 2020Co-Authors: P Gajdos, S Chevret, K ToykaAbstract:Myasthenia gravis is an autoimmune disease. In up to 90 per cent of cases IgG autoantibodies to the nicotinic acetylcholine receptor are detectable which mediate the neuromuscular transmission disorder. As with other autoimmune diseases, patients would be expected to benefit from intravenous immunoglobulin. Case series and two randomised controlled trials suggest that intravenous immunoglobulin may be beneficial. The objective of this review is to examine the efficacy of intravenous immunoglobulin for treating exacerbations of Myasthenia gravis or for chronic Myasthenia gravis. We searched the Cochrane Neuromuscular Disease Group trials register (21 July 2002) and MEDLINE (January 1966 to July 2002) using 'Myasthenia gravis' and 'intravenous immunoglobulin' as the search terms. All randomised or quasi-randomised trials in which intravenous immunoglobulin was compared with no treatment, placebo or plasma exchange, in people with Myasthenia gravis who were diagnosed by an internationally accepted definition. One author extracted the data and the two others checked these data and the source from which they were derived. For methodological reasons, no formal meta-analysis was performed. We identified four randomised controlled trials (147 participants in total), all investigating short-term benefit. In the first study of 87 people with Myasthenia gravis exacerbation, comparing intravenous immunoglobulin and plasma exchange, there was no statistically significant difference between the efficacy of the two treatments after two weeks. In the second study 12 people with moderate or severe Myasthenia gravis were treated in a cross-over design trial with intravenous immunoglobulin or plasma exchange: no statistically significant difference in the efficacy of the two treatments was found after four weeks. In the third study 15 people with mild or moderate Myasthenia gravis received intravenous immunoglobulin or a placebo: no significant difference in efficacy of intravenous immunoglobulin or placebo was found six weeks after treatment. The last study, which included 33 people with moderate exacerbations of Myasthenia gravis, compared intravenous immunoglobulin and methylprednisolone and showed no statistically significant difference in the efficacy of the two treatments. One randomised controlled trial did not show a significant difference between intravenous immunoglobulin and plasma exchange for treatment of severe exacerbations of Myasthenia gravis. There is no evidence from randomised controlled trials to determine whether intravenous immunoglobulin for moderate or severe Myasthenia gravis improves functional outcome or has a sparing effect on steroid dosage, nor is there sufficient evidence to favour intravenous immunoglobulin over steroids in moderate exacerbations. Further randomised controlled trials are needed.
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intravenous immunoglobulin for Myasthenia gravis
Cochrane Database of Systematic Reviews, 2012Co-Authors: P Gajdos, S Chevret, K ToykaAbstract:Background Myasthenia gravis is an autoimmune disease in which autoantibodies interfere with neuromuscular transmission. As with other autoimmune diseases, people with Myasthenia gravis would be expected to benefit from intravenous immunoglobulin (IVIg). This is an update of a review first published in 2003 and last updated in 2007. Objectives To examine the efficacy of IVIg for treating exacerbations of Myasthenia gravis or for chronic Myasthenia gravis. Search methods We searched the Cochrane Neuromuscular Disease Group Specialized Register (11 October 2011), CENTRAL (2011, Issue 3), MEDLINE (January 1966 to September 2011) and EMBASE (January 1980 to September 2011) using 'Myasthenia gravis' and 'intravenous immunoglobulin' as the search terms. Selection criteria All randomised controlled trials (RCTs) or quasi-RCTs in which IVIg was compared with no treatment, placebo or plasma exchange, in people with Myasthenia gravis. Data collection and analysis One review author extracted the data and two others checked these data. For methodological reasons, no formal meta-analysis was performed. Main results We identified seven RCTs. These trials differ in inclusion criteria, comparison with alternative treatment and outcomes. In a trial comparing IVIg with placebo, including 51 participants with Myasthenia gravis worsening, the mean difference (MD) in quantitative Myasthenia gravis score (QMGS) (MD 95% CI) after 14 days was: -1.60 (95% CI - 3.23 to 0.03) this result being borderline statistically significant in favour of IVIg. In an unblinded study of 87 participants with exacerbation comparing IVIg and plasma exchange there was no difference in myasthenic muscle score (MMS) after 15 days (MD -1.00; 95% CI -7.72 to 5.72). In a study of 84 participants with worsening Myasthenia gravis there was no difference in change in QMGS 14 days after IVIg or plasma exchange (MD -1.50; 95% CI -3.43 to 0.43). In a study of 12 participants with moderate or severe Myasthenia gravis, which was at high risk of bias from skewed allocation, the mean fall in QMGS both for IVIg and plasma exchange after four weeks was significant (P < 0.05). A study with 15 participants with mild or moderate Myasthenia gravis found no difference in change in QMGS 42 days after IVIg or placebo (MD 1.60; 95% CI -1.92 to 5.12). A study included 33 participants with moderate exacerbations of Myasthenia gravis and showed no difference in change in QMGS 14 days after IVIg or methylprednisolone (MD -0.42; 95% CI -1.20 to 0.36). All these three smaller studies were underpowered. The last trial, including 168 people with exacerbations, showed no evidence of superiority of IVIg 2 g/kg over IVIg 1 g/kg on the change of MMS after 15 days (MD 3.84; 95% CI -0.98 to 8.66). Adverse events due to IVIg were moderate (fever, nausea, headache), self-limiting and subjectively less severe than with plasma exchange (although, given the available data, no statistical comparison was possible). Other than where specific limitations are mentioned the trials were generally at low risk of bias. Authors' conclusions In exacerbation of Myasthenia gravis, one RCT of IVIg versus placebo showed some evidence of the efficacy of IVIg and two did not show a significant difference between IVIg and plasma exchange. Another showed no significant difference in efficacy between 1 g/kg and 2 g/kg of IVIg. A further, but underpowered, trial showed no significant difference between IVIg and oral methylprednisolone. In chronic Myasthenia gravis, there is insufficient evidence from RCTs to determine whether IVIg is efficacious.
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Intravenous immunoglobulin for Myasthenia gravis.
The Cochrane database of systematic reviews, 2008Co-Authors: P Gajdos, S Chevret, K ToykaAbstract:Myasthenia gravis is an autoimmune disease in which autoantibodies interfere with neuromuscular transmission. As with other autoimmune diseases, people with Myasthenia gravis would be expected to benefit from intravenous immunoglobulin (IVIg). The objective of this review was to examine the efficacy of intravenous immunoglobulin for treating exacerbations of Myasthenia gravis or for chronic Myasthenia gravis. We searched the Cochrane Neuromuscular Disease GroupTrials Register (April 2007) and MEDLINE (January 1966 to May 2007) using 'Myasthenia gravis' and 'intravenous immunoglobulin' as the search terms. We included all randomised or quasi-randomised trials in which intravenous immunoglobulin was compared with no treatment, placebo or plasma exchange, in people with Myasthenia gravis. One review author extracted the data and two others checked these data and the source from which they were derived. For methodological reasons, no formal meta-analysis was performed. We identified six randomised controlled trials, all of which investigated short-term benefit. A trial of IVIg compared with placebo including 51 patients provided evidence for the effectiveness of IVIg in Myasthenia gravis worsening. A study of 87 participants with exacerbation found no statistically significant difference between immunoglobulin and plasma exchange after two weeks. A study of 12 participants with moderate or severe Myasthenia gravis treated in a crossover design trial found no statistically significant difference in the efficacy of immunoglobulin and plasma exchange after four weeks. A study with 15 participants with mild or moderate Myasthenia gravis found no statistically significant difference in efficacy of IVIg and placebo after six weeks. A study included 33 participants with moderate exacerbations of Myasthenia gravis and showed no statistically significant difference in the efficacy of IVIg and methylprednisolone. The last trial including 173 people with Myasthenia gravis exacerbations, showed no superiority of IVIg 1 g/kg on two consecutive days over IVIg 1 g/kg on a single day. In exacerbation of Myasthenia gravis, one randomised controlled trial of IVIg versus placebo demonstrated the efficacy of IVIg and another did not show a significant difference between IVIg and plasma exchange. Another showed no significant difference in efficacy between 1 g/kg and 2 g/kg of IVIg. A further, but underpowered, trial showed no significant difference between IVIg and oral methylprednisolone. In chronic Myasthenia gravis, there is insufficient evidence from randomised trials to determine whether IVIg is efficacious. More research is needed to determine whether IVIg reduces the need for corticosteroids as suggested by two case series.
Wei Dong-ning - One of the best experts on this subject based on the ideXlab platform.
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The Treatment of Myasthenia gravis
Progress in Modern Biomedicine, 2020Co-Authors: Wei Dong-ningAbstract:Acquired Myasthenia gravis is an autoimmune disease that affects the neuromuscular junctions.The target of the autoimmune attack in most cases is the skeletal muscle acetylcholine receptor(AChR).The final result remains muscle endplate dysfunction and muscle weakness.Most of patients with Myasthenia gravis need a certain immune therapy in different courses of disease to induce a completed remission or near remission of symptoms and maintain it.In this review,the conventional methods and new progresses of management of myastheia gravis will be reviewed,including acetylcholinesterase inhibitors,immune modulationg therapy and thymectomy.The dosage,usage,course of treatment,indication,side effect of drugs and measures to side effect will be introduced.The primary aim of treatment of Myasthenia gravis is induction and maintenance of clinical or pharmacologic remission while minimizing adverse effects of therapy.Treatment decisions must be individualized based on clinical classification,severity and coexisting disease,and patient participation in these decisions is essential to successful management.During the past decade,the prognosis of Myasthenia gravis was improved significantly as which the imm une therapies,especiall y newly immunosuppressant was used in treatment of Myasthenia gravis.So,newly immunosuppressant such as cycloporine,mycophenolate mofetil,tacrolimus,rituxmiab and their pharmacological mechanisms will be focused on in this review.
