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Ann. N.Y. Acad. Sci., Annals PrePrint, published online ahead of print December 20, 2007 doi: 10.1196/annals.1405.001 Copyright © 2007 by the New York Academy of Sciences description
1 Intensive care department, Raymond Poincaré teaching hospital, Assistance publique-Hopitaux de Paris, Garches. VSQ university. France, Jouy en Josas, France 2 Biostatistics and medical informatics department, Saint Louis teaching hospital. Assistance publique-Hopitaux de Paris, U 717- INSERM Paris 7 University. France, Paris, Seine, France
* To whom correspondence should be addressed. E-mail: mp.gajdos{at}9online.fr. PrePrint Abstract
Four RCTs examined the efficacy of IVIG for MG acute exacerbations. The first compared PE and IVIG. Eighty-seven patients were included. At day 15, the mean change in the Myasthenic Muscular Score (MMS) was 16.6 (95% CI 11.6 to 21.6) in the PE group and 15.6 (95% CI 10.9 to 20.3) in the IVIG group (P value = 0.65 Wilcoxon test). The second compared IVIG to oral methylprednisolone.Thirty-three patients were included. The mean (SD) sum of the two most pathological items of the Quantitative Myasthenia Gravis Score (QMGS) at day 0 was 3.9 (1.1) for the IVIG group and 4.2 (0.7) for the methylprednisolone group. At day 14 these values were 2.9 (1.4) for the IVIG group and 2.8 (1.1) for the methylprednisolone group. The third compared IVIG 2g/kg versus placebo for MG worsening. The mean change in QMGS at day 14 was -2.54 in the IVIG group and -0.89 in the placebo group (p: 0.047). A significant IVIG treatment effect was observed only in patients with more severe disease: the mean difference was -0.10 for mild MG (p: 0.914) and -3.39 for moderate to severe MG (p: 0.010). The last trial compared IGIV 2g/kg versus 1g/kg for MG acute exacerbation. One hundred and seventy-three patients were included. The mean MMS change in both groups was similar (difference = 3.84 (95% CI -1.03 to 8.71; P value = 0.12).In conclusion: IVIG may be used as treatment for MG acute exacerbations. A dose of IVIG 1g/kg may be sufficient. Key Words:
myasthenia gravis, exacerbation, IVIG
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