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We treated 16 patients with moderately severe to severe generalized myasthenia gravis(MG)by immunoadsorption(perfusion through a resin that adsorbs proteins)of 2,500 mg plasma on each of four alternate days. Fourteen patients who completed treatment all had significant improvement in strength(6 excellent,6 good and 2 fair)which began a mean of 42 hours after the first immunoadsorption,reached a maximum four days after the fourth immunoadsorption(mean 250%of baseline strength)and returned to the baseline over a mean of 2 months.Eight patients had transient symptomatic hypotension attributable to withdrawal of blood more rapidly than it was returned;this hypotension was prevented or ameliorated by intravenous saline.Immunoadsorption is safe and effective in the management of MG and may be preferable to plasma exchange,because protein replacement is unnecessary and side effects may be less marked. |
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