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 MG include plasma exchange(PLEX), 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 patients with MG who have SLE/RA.
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 patients with SLE/RA and excluded patients missing identifiers(age, gender, death). Patients who received both PLEX and IVIG during the same hospitalization were excluded as combined treatment may affect outcomes. Data analyses assessed length of stay(LOS), total charges and mortality.
Setting : Nationwide Inpatient Sample Administrative Database,2012-2015
Participants (or Animals, Specimens, Cadavers) : Patient encounters documented in Nationwide Inpatient Sample Database.
Interventions : Not applicable.
Main Outcome Measure(s) :
Mortality, total charges, length of stay
Of the 2,604 who received either PLEX or IVIG, 212 patients had SLE(109 underwent PLEX, 103 underwent IVIG), and 179 patients had RA(101 underwent PLEX, 78 underwent IVIG). In comparison to patients receiving IVIG, significant increases were observed in the PLEX group:
In SLE patients:
· LOS(7.43 vs. 10.2 days,p
· Mortality(1.5% vs. 3.2%,p
· Total charges($98,115 vs. $107,939.41,p=0.018).
In RA patients:
· LOS(6.50 vs. 9.15 days,p=0.0012).
· Mortality(3.3% vs. 5.9%,p
· Total charges($91,022.63 vs. $110,067.50,p
Patients with concomitant RA or SLE 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. 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