Comparison of Efficacy Between Lymphoplasmapheresis and Plasma Exchange in Myasthenic Crisis.

INTRODUCTION/AIMS: Lymphoplasmapheresis (LPE) is an innovative therapy that integrates traditional plasma exchange (PE) with leukapheresis. PE is widely established as a standard treatment for myasthenia gravis (MG) crisis, but the therapeutic potential of LPE in myasthenic crisis (MC) remains unclear. Therefore, this study aimed to compare the efficacy of LPE versus PE in the management of MC.

METHODS

This was a retrospective cohort study that included 86 MC patients who were treated with either LPE (n = 47) or PE (n = 39). Primary outcome indicators were total length of hospitalization, duration of mechanical ventilation (MV), and length of stay in the intensive care unit (ICU). Secondary outcome indicators included quantitative myasthenia gravis (QMG) scores at 1 and 2 months following the onset of the crisis.

RESULTS

Both LPE and PE demonstrated good tolerance in the crisis treatment. Patients in the PE cohort received an average of 3.87 replacements, compared to 2.26 in the LPE cohort. Compared to PE, LPE was associated with significantly shorter durations of MV (8.50 ± 4.69 vs. 11.73 ± 4.61 days, p = 0.016) and ICU stay (11.88 ± 5.78 vs. 15.92 ± 5.54 days, p = 0.013). Functional outcomes were also better in the LPE cohort, as demonstrated by lower QMG scores at 1- and 2-months post-crisis (p < 0.05). PE and LPE effectively decreased the levels of autoantibodies against acetylcholine receptors (AChR-Ab) and inflammatory cytokines, with LPE exhibiting superior performance.

DISCUSSION: In MC, LPE may be a better choice for treatment than traditional PE.