Category: Neurodegenerative Disease (e.g. MS, Parkinson's disease); Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Myasthenia gravis(MG) is an autoimmune neuromuscular disease caused by auto-antibodies binding to post-synaptic nicotinic acetylcholine receptors. Standard therapy for symptomatic MG include plasma exchange(PLEX), also known as plasmapheresis, and intravenous immunoglobulin(IVIG). To date, neither PLEX or IVIG has established superior clinical benefit. This study aims to compare PLEX vs. IVIG in smokers with MG.
This retrospective cohort study utilized the Nationwide Inpatient Sample to identify patients(18+) from 2012-2015 with a primary diagnosis of MG undergoing PLEX or IVIG. ICD-9 codes identified smokers and excluded patients missing identifiers(age, gender, death). Patients who received both PLEX and IVIG during the same hospitalization were also excluded as combined treatment may affect outcomes. Data analyses assessed length of stay(LOS), total charges, mortality and age of admission.
Nationwide Inpatient Sample Administrative Database,2012-2015
Participants (or Animals, Specimens, Cadavers) :
Patient encounters documented in Nationwide Inpatient Sample Database.
Main Outcome Measure(s) :
Mortality, total in-hospital charges, length of stay, age of admission.
Of the 2,604 receiving either PLEX or IVIG, 370 patients were smokers(181 underwent PLEX, 189 underwent IVIG). In comparison to patients who received IVIG, significant increases were observed in the PLEX group:
· LOS(6.43 vs. 10.5,p
· Total charges($96,348.02 vs. $117,296.16,p
· Mortality(1.6% vs. 3.3%,p=0.004)
Smokers who underwent PLEX suffer from increased LOS, mortality, and total charges when compared to IVIG. The results of this study can aid clinicians in making treatment decisions within this population. Limitations include inability to determine length of smoking history or severity of MG. Peri-procedural optimization of symptomatic patients is one avenue to improve patient outcomes.
Andrew Dang– Anatomy Fellow, Kansas City University of Medicine and Biosciences, Kansas City, Missouri
Derek Schirmer– Anatomy Fellow, Kansas city university of medicine and Biosciences, Kansas City, Missouri
Russell Arellanes– Anatomy fellow, Kansas City University of Medicine and Biosciences, Kansas City, Missouri
Barth Wright– Professor, Chair, Dept. of Anatomy, Kansas City University of Medicine and Biosciences, Kansas City, Missouri