Investigators at Boston Children's Hospital and at University of Florida, Gainesville, studied the comparative efficacy of plasmapheresis (PLEX) vs immunoglobulin (IVIG) as maintenance therapy in juvenile myasthenia gravis (MG). A retrospective analysis over a 33-year period involved 54 children and adolescents with juvenile MG. Seven of 7 treated with PLEX alone responded, 5 of 10 treated with IVIG alone responded, and 9 of 10 patients who received both responded. Response rate to PLEX was significantly higher and more consistent than that of IVIG. Of 17 patients treated by thymectomy, 11 were significantly benefited. [1]

COMMENTARY. PLEX and IVIG both have high response rates as maintenance therapies for juvenile MG, but PLEX response is superior. Nine of 11 patients with response graded as “B”-good improvement [2, 3], had early thymectomies.