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. 2022 Oct 11:13:1018509.
doi: 10.3389/fneur.2022.1018509. eCollection 2022.

Application of lymphoplasmapheresis in the treatment of severe myasthenia gravis

Weiwei Duan  1 , Hao Zhou  1 , Xiaohua Dong  1 , Bijuan Li  2 , Yi Li  1 , Haobing Cai  1 , Qian Zhou  1 , Song Ouyang  3 , Weifan Yin  4 , Huan Yang  1
Affiliations

Application of lymphoplasmapheresis in the treatment of severe myasthenia gravis

Weiwei Duan et al. Front Neurol. .

Abstract

Background: Lymphoplasmapheresis (LPE) is a treatment that combines traditional plasma exchange and lymphocyte removal technique. It has been applied to treat a variety of autoimmune diseases, but its application value in the treatment of severe myasthenia gravis (MG) is not yet clear. Therefore, the aim of this study was to investigate the efficacy and safety of LPE in severe MG.

Methods: Clinical data of 123 severe patients with MG (Myasthenia Gravis Foundation of America Clinical Classification, Class IV) who received LPE treatment were included in a retrospective analysis. Efficacy was evaluated by the change of Quantitative Myasthenia Gravis score (QMGS) before and after treatment. Univariate and multivariate logistic regression analysis was used to explore clinical factors affecting efficacy.

Results: A total of 220 replacements were performed in 123 patients, with an average of 1.79 replacements per patient. The overall safety of LPE was good, and no serious adverse reactions occurred. After treatment, the mean QMGS of patients decreased significantly, from 23.40 ± 4.25 points before treatment to 17.93 ± 5.61 points after treatment, a decrease of 5.47 ± 4.16 points. 75.6% of patients experienced remission of clinical symptoms. During a 2-month follow-up of 64 patients, a progressive improvement in QMGS was found. Each muscle group involved in MG responded well to LPE treatment. In addition, LPE significantly reduced the levels of AChR-Ab and inflammatory cytokines in patients. Age ≥ 50 years and co-infection were unfavorable factors affecting the efficacy.

Conclusions: In this study cohort, LPE is safe for the treatment of severe MG and achieves good treatment outcome with fewer replacements. In patients with MG, the avoidance and timely control of infection are necessary. Our study provides a potential new treatment option for severe MG.

Keywords: efficacy; immunotherapy; lymphoplasmapheresis; myasthenia gravis; safety.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The flowchart designed for this study.
Figure 2
Figure 2
Changes in QMGS before and after treatment. (A) Changes in overall QMGS before and after treatment. (B) Changes in QMGS of patients before treatment, 14, 30, and 60 days after treatment completion. (C) Changes in QMGS of ocular muscles before and after treatment. (D) Changes in QMGS of limb muscles before and after treatment. (E) Changes in QMGS of bulbar muscles before and after treatment. (F) Changes in QMGS of respiratory muscles before and after treatment. ***p < 0.001.
Figure 3
Figure 3
Changes of immune indexes before and after treatment. (A) Changes of AChR-Ab titer before and after treatment. (B) Changes in the number of lymphocytes before and after treatment. (C) Changes in IgG titer before and after treatment. (D–F) Changes of proinflammatory factors IL-1β (D), TNF-α (E), and IL-6 (F) before and after treatment. ***p < 0.001.
Figure 4
Figure 4
Forest plot of multivariate logistic regression analysis results.
See this image and copyright information in PMC

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