Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis
Gamez, Josep (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Salvadó, Maria (Hospital Universitari Vall d'Hebron)
Carmona, Francesc (Universitat de Barcelona. Departament de Genètica, Microbiologia i Estadística)
Nadal Clanchet, Miriam de (Universitat Autònoma de Barcelona)
Romero, Laura (Hospital Universitari Vall d'Hebron)
Ruiz, Daniel (Universitat Autònoma de Barcelona)
Jáuregui, Alberto (Hospital Universitari Vall d'Hebron)
Martínez, Olga (Universitat Autònoma de Barcelona)
Pérez, Javier (Hospital Universitari Vall d'Hebron)
Suñé, Pilar (Hospital Universitari Vall d'Hebron)
Deu, Maria (Hospital Universitari Vall d'Hebron)

Data:	2019
Resum:	Background: Myasthenic crisis (MC) is a potentially life-threatening complication of myasthenia gravis. Its precipitating factors include surgical procedures, particularly thymectomy. The role of preoperative intravenous immunoglobulin (IVIg) in preventing MC in patients scheduled for thymectomy and other surgery with general anaesthesia is unknown. Our objective was to test the hypothesis that preoperative IVIg is effective in preventing myasthenic crisis in patients with myasthenia gravis scheduled for surgery under general anaesthesia, including thymectomy. Methods: A prospective, randomized, double-blind, single-centre study was conducted over a 4-year period. The treatment group received IVIg, 0. 4 g/kg/day preoperatively for 5 consecutive days, and the placebo group received saline solution under the same conditions. The two groups were age-matched, with similar functional status, and Myasthenia Gravis Foundation of America class. All patients had well-controlled myasthenia gravis with minimal manifestations before surgery. The primary outcome measured was MC. Intubation times, time in the recovery room, number of postoperative complications, and days of hospitalization were the secondary outcomes measured. Results: A total of 47 patients were randomized, 25 to the IVIg group and 22 to placebo. There were 19 men and 28 women, with a mean age of 58. 6 years, mean body mass index of 27. 8 kg/m, and mean acetylcholine receptor antibodies of 12. 9 nmol/l. The mean forced vital capacity was 84. 4%. The mean quantitative myasthenia gravis sum score was 6. 3. Ten patients (five in each arm) had a history of MC. Thymectomy was performed in 16 patients. Only one patient in the placebo group presented with MC requiring non-invasive ventilation (but no reintubation) for 6 days. Neither differences between groups in the univariate analysis nor risk factors for MC in the multivariate analysis were found. Conclusions: Preoperative IVIg to prevent MC does not appear to be justified in well-controlled myasthenia gravis patients. This study provides class I evidence that preparation with IVIg to prevent MC is not necessary in well-controlled myasthenia gravis patients scheduled for surgery with general anaesthesia.
Nota:	The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by a Fondo de Investigación Sanitaria (FIS-FEDER) (grants PI16-01673 and PI19/00593) and an Interlaken Research Award Programme (2012-12094537).
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Clinical trial ; Immunoglobulin ; Myasthenia ; Myasthenic crisis ; Thymectomy
Publicat a:	Therapeutic Advances in Neurological Disorders, Vol. 12 (january 2019) , ISSN 1756-2864

DOI: 10.1177/1756286419864497
PMID: 31360225

13 p, 487.7 KB

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