Abstract
Factors determining response to intravenous immunoglobulin (IVIg) and plasmapheresis in myasthenia gravis (MG) have not been evaluated systematically. This study included patients treated with IVIg (n = 63) or plasmapheresis (n = 42) from two trials evaluating IVIg vs. placebo or plasmapheresis in MG. Response was defined as improvement in the quantitative myasthenia gravis score (QMGS) of ≥3.5 points at day 14. Baseline clinical, electrophysiological, and immunological factors were analyzed as predictors. Baseline QMGS, acetylcholine receptor antibody (AChRAb) positivity, single-fiber electromyography (SFEMG) jitter, and percent abnormal pairs and percent blocking pairs were higher in responders than in non-responders. Using multivariate logistic regression, the odds ratio for response was 13.0 (1.01-381.5) in QMGS 11-17 and 15.3 (1.34-414.3) in QMGS >17 compared with QMGS <11. Baseline QMGS, AChRAb positivity, and SFEMG parameters were more abnormal in patients who responded to treatment. Using multivariate regression, baseline QMGS remained as the only significant independent predictor of response.
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