Although clinical trials suggest that intravenous immunoglobulin (IVIg) and plasma exchange are equally effective in the treatment of impending or manifest myasthenic crisis, expert consensus suggests that plasma exchange is more effective and works more quickly.
The Spectra Optia system is the first therapeutic apheresis system indicated to treat myasthenia gravis (MG). Using plasma exchange on the Spectra Optia system results in a fast road to recovery for majority of MG patients by delivering a rapid clinical response.
1Elovaara I, et al. Eur J Neurol. 2008; 15:893-908. 2Raphaël JC, et al. Cochrane Database Syst Rev. 2012(7). 3Schwartz J, et al. J Clin Apher. 2016; 31(3):149-162. 4Sanders DB, et al. Neurology. 2016; 87(4):419-425.
In choosing a therapy, seeing results as quickly as possible is critical in order to hasten recovery or maintain optimal symptom management. Plasma exchange rapidly removes disease mediators, essentially quieting the immune response and relieving symptoms. (Derksen, 1984) For MG crisis, this means hastening recovery, such as enabling the patient to come off the ventilator faster and achieve quicker functional outcome improvement. (Quereshi et al., 1999)
Saperstein D, Barohn R. Management of myasthenia gravis. Semin Neurology. 2004;24(1):41-48.
Studies show that plasma exchange treatment provides significant clinical benefits when used as a stand-alone therapy for MG patients, including generalized, refractory, crisis and MuSK+. (Sanders, 2016)
Multiple studies and expert opinion support that plasma exchange has superior efficacy over IVIg for MuSK+ MG.(Guptil et al., 2011) (Pasnoor et al., 2010) (Vincent, 2008)
The international consensus guidance for management of myasthenia gravis states, "MuSK-MG responds well to PLEX, while IVIg seems to be less effective." (Sanders et al., 2016)
Retrospective chart review of 53 MuSK-Ab-positive MG patients at nine university-based centers in the U.S. showed that 51 percent of patients improved with plasma exchange versus 20 percent with IVIg. (Pasnoor et al., 2010)
In a 2011 review of 110 MuSK- MG patients from two large clinics in Italy and the U.S., plasma exchange produced improvement in 93 percent of patients, compared with only 61 percent who improved after IVIg. (Guptil et al., 2011)
Long-term outcome (3 years) was very favorable in 58 percent of patients who achieved remission and/or minimal manifestation status. (Pasnoor et al., 2010)
Plasma exchange can be performed peripherally
Possible patient reactions
Reactions to transfused blood products can include1
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1AABB (ed.), et al., Circular of Information for the Use of Human Blood and Blood Components. 2006, tenth edition, Council of Europe Publishing, Seattle, WA.
2American Society for Apheresis. Guidelines for therapeutic apheresis clinical privileges. J Clin Apher. 2007;22(3):181-182.
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