Comparing the Effectiveness of IVIG and PLEX for Treatment of Neuromuscular Disorders (P6.458)

2018 
Objective: NA Background: Intravenous immunoglobulins (IVIG) and plasma exchange (PLEX) are usually the initial treatment plan for acute inflammatory demyelinating polyneuropathy (AIDP) or for exacerbations in chronic disorders such as myasthenia gravis (MG) and chronic inflammatory demyelinating polyneuropathy (CIDP). The combination of IVIG and PLEX has been tried when patients are severe but there is no validated study to clarify whether the combination is better than either therapy alone. There is little data on comparison of IVIG and PLEX for MG and CIDP. We hypothesized that there is no definitive benefit from combination therapy. Design/Methods: We reviewed charts from 118 adults with confirmed individual diagnoses of MG, AIDP, or CIDP and were admitted in hospital from 2010–2017. The demographic details, prior treatments, and clinical exam, length of stay, ventilator requirements were abstracted from the charts. Results: 66 males and 51 females, with the majority over 60 years of age and Caucasian were identified. 35 MG, 35 CIDP and 48 AIDP patients were reviewed. 86 patients received IVIG first, 20 received PLEX first and 12 received both treatments. There was an equal number of CIDP, MG and AIDP receiving both treatments. CIDP patients were more likely to be within first year of diagnosis (69%) whereas MG patients were more likely to have had disease longer than one year (66%). Conclusions: There is a bias of treatment based on diagnosis. Overall IVIG was more commonly used at our institution. MG was more likely to be treated with PLEX first than other disorders, whereas almost all AIDP patients and majority of CIDP were treated with IVIG first. The few patients receiving both treatments limits conclusions of efficacy for both treatments. Disclosure: Dr. Khalid has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Donofrio has nothing to disclose. Dr Peltier has nothing to disclose.
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