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IV immunoglobulin in patients with myasthenia gravis

A randomized controlled trial

From the Sunnybrook Health Sciences Centre (L.Z.) and University Health Network (E.N., V.B.), University of Toronto, Ontario, Canada.

Address correspondence and reprint requests to Dr. V. Bril, 13N, 1382, Toronto General Hospital, UHN, 585 University Ave., Toronto, Ontario, Canada M5G 2N2; e-mail: vera.bril{at}utoronto.ca

Objective: We aimed to determine the effectiveness of IV immunoglobulin (IVIG) in the treatment of patients with myasthenia gravis (MG) and worsening weakness in a randomized, placebo-controlled, masked study.

Methods: Fifty-one patients with worsening weakness due to MG were randomized to infusion with 2 g/kg of IVIG or an equivalent volume of IV dextrose 5% in water. The Quantitative Myasthenia Gravis (QMG) Score for Disease Severity, a validated clinical composite scale, was calculated by a masked observer at baseline and days 14 and 28.

Results: In IVIG-treated patients, a clinically meaningful improvement in QMG Score for Disease Severity was observed at day 14 and persisted at day 28. The greatest improvement occurred in patients with more severe disease as defined by a QMG Score for Disease Severity greater than 10.5.

Conclusion: This study provides level 1 evidence for the effectiveness of IV immunoglobulin in patients with worsening weakness due to myasthenia gravis.

Editorial, see page 803

Disclosure: Talecris (formerly Bayer) provided an unrestricted education grant for this study. Bayer/Talecris was not involved in the study design, conduct of the study, collection and management of data, or interpretation of results. A Bayer statistician provided technical support and review of our own analyses of the data. Bayer/Telecric did not play a role in the preparation or approval of the manuscript..

Received July 14, 2006. Accepted in final form October 19, 2006.

Related articles in Neurology:

IVIG in myasthenia gravis: Getting enough "bang for the buck"

Matthew N. Meriggioli
Neurology 2007 68: 803-804. [Full Text]  

This article has been cited by other articles:

				R. J. BAROHN Treatment and Clinical Research in Myasthenia Gravis: How Far Have We Come? Ann. N.Y. Acad. Sci., June 1, 2008; 1132(1): 225 - 232. [Abstract] [Full Text] [PDF]

				L. ZINMAN and V. BRIL IVIG Treatment for Myasthenia Gravis: Effectiveness, Limitations, and Novel Therapeutic Strategies Ann. N.Y. Acad. Sci., June 1, 2008; 1132(1): 264 - 270. [Abstract] [Full Text] [PDF]

				Additional articles abstracted in ACP Journal Club Evid. Based Med., October 1, 2007; 12(5): 158 - 158. [Full Text] [PDF]

				M. N. Meriggioli IVIG in myasthenia gravis: Getting enough "bang for the buck" Neurology, March 13, 2007; 68(11): 803 - 804. [Full Text] [PDF]