From the Guidelines
The advantage of using intravenous immune globulin (IVIG) instead of plasma exchange for short-term immunomodulation in patients with severe myasthenia gravis or during an exacerbation is the greater ease of administration. IVIG can be administered in most hospital settings without specialized equipment or personnel, whereas plasma exchange requires specialized equipment, trained staff, and vascular access. Both IVIG and plasma exchange are effective treatments for myasthenia gravis exacerbations, with similar efficacy and time to benefit (typically 1-2 weeks) 1. However, IVIG is not FDA-approved specifically for myasthenia gravis, though it is commonly used off-label for this purpose. The available randomized controlled trial data does not demonstrate that IVIG has greater efficacy than plasma exchange; studies suggest they have comparable effectiveness 1. Some key points to consider when choosing between these treatments include:
- Local availability of the treatment options
- Patient-specific factors, such as the presence of comorbidities or contraindications to one of the treatments
- Institutional experience with the treatments
- Cost and accessibility of the treatments, particularly in low-income and middle-income countries 1. Overall, the choice between IVIG and plasma exchange should be individualized based on the specific needs and circumstances of each patient.
From the Research
Advantages of IVIG over Plasma Exchange
- The greater ease of administration is an advantage of using intravenous immune globulin (IVIG) instead of plasma exchange for short-term immunomodulation in patients with severe myasthenia gravis (MG) or an exacerbation 2.
- There is no evidence to suggest that IVIG has FDA approval specifically for treating MG, or that there is randomized controlled trial data demonstrating greater efficacy than plasma exchange 3, 4, 2, 5.
- The time to benefit is not clearly established as an advantage of IVIG over plasma exchange, with some studies suggesting that plasma exchange may have a faster efficacy in the first two weeks of treatment 3, 4.
Comparison of IVIG and Plasma Exchange
- Studies have compared the efficacy and safety of IVIG and plasma exchange in patients with myasthenia gravis, with some finding similar efficacy between the two treatments 3, 2.
- Other studies have found that plasma exchange may be associated with a reduced ICU stay length and an early response in patients with myasthenic crisis 4.
- The tolerance of IVIG has been found to be better than that of plasma exchange, with fewer side effects reported 2.