Short-Term Immunotherapies

Plasmapheresis:
Plasmapheresis removes antibodies from the circulation, producing short-term clinical improvements. This is done by a procedure that usually entails five exchange treatments of 3 to 4 liters each, carried out over a two-week period. It is used primarily to stabilize the condition of patients in myasthenic crisis or for the short-term treatment of patients undergoing thymectomy. The effects are rapid; improvements occur within days of treatment. Improvement correlates roughly with reduction in the anti-acetylcholine receptor antibody titers. Unfortunately, effects are temporary, lasting only weeks. For those rare cases that other methods of treatment do not work, plasmapheresis can be used as a long-term therapy. Some negative aspects of the plasmapherisis process are problems with venous access, risk of infection of the indwelling catheter, hypotension, and pulmonary embolism.

Intravenous Immune Globin:
Another short-term process is intravenous immune globin. It produces rapid improvement to help patienst through a difficult period of myasthenic weakness. An extraordinary benefit of this process is that it does not require special equipment, and the usual dose is small, only 400 mg per kilogram per day for five successive days. Adverse reaction occur in fewer than 10 percent of patients. Symptoms include headache, fluid overload, and in rare cases, renal failure. In patients who respond, improvement begins within four or five days, and may be sustained for weeks to months. The mechanism of action remains unknown and the process is very expensive.

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