Comparative Efficacy of IVIG and Plasma Exchange in Myasthenic Crisis: A Meta-Analysis

Introduction: Myasthenia Crisis is the most severe form of Myasthenia gravis which is marked by
abrupt respiratory failure that needs rapid treatment and immunomodulator therapy.
Although Plasma Exchange and Intravenous Immunoglobulin (IVIG) therapies are
recommended, we are not sure which is superior to another and this can cause global
practice inconsistency. This meta analysis was done to synthesize existing evidence
and clarify which is better in myasthenia crisis


Methods: A systematic search of PubMed, Embase, Google Scholar and Cochrane databases
was conducted to find studies that compare plasma Exchange to IVIG. Four studies
met inclusion criteria. Data were pooled using inverse variance weighting with a
random-effects model in R Studio. Forest plots were used to illustrate pooled effect
estimates, and heterogeneity was assesed


Results: A total of 3901 myasthenia crisis cases from 4 studies were included, where they were
treated with either plasma exchange or IVIG. IVIG showed significantly less mortality
compared to plasma exchange (RR 0.50; 95% CI: 0.26, 0.97; p=0.039). Duration of
intubation was slightly shorter with plasma exchange but is not statistically significant
(MD -2.66; 95% CI: -9.23, 3.91; p=0.43). Also there is no difference observed for
length of stay between plasma exchange and IVIG (MD -0.26; 95% CI: -10.36, 9.85;
p=0.96).


Conclusions: IVIG showed lower mortality in myasthenia crisis, but length of intubation and length
of hospital stay were comparable between IVIG and plasma exchange. Future research
should focus on refining ICU protocols, exploring sequential/combination therapy,
and stratify outcomes based on MG Serotype, age and comorbidities to personalize
the treatment protocols