Efficacy And Safety Of Intravenous Immunoglobulin And Plasma Exchange In The Treatment Of Generalised Myasthenia Gravis:Meta-analysis

Objective:In this study,Meta-analysis was used to compare the efficacy and safety of plasma exchange and intravenous immunoglobulin in the treatment of generalised myasthenia gravis.Evidence-based evidence was provided for the treatment of systemic myasthenia gravis.Methods:The English literature was searched through Web of Science,Pubmed,Cochrane.The keywords in English were "myasthenia gravis","Plasmapheresis","plasma exchange",and "Intravenous immunoglobulin".The Chinese literature was retrieved through CNKI and Wanfang.The Chinese key words were "myasthenia gravis","plasma exchange" and "immunoglobulin".The retrieval time is from database establishment time to February 20,2018,included in the control test all plasmapheresis and intravenous immunoglobulin in the treatment of myasthenia gravis,one by one data extraction,and to evaluate the quality of included studies,randomized controlled trials performed according to the Cochrane standard of bias risk assessment,using non randomized controlled trials the NOS standard evaluation,finally the application of the Cochrane collaboration’s RevMan 5.3 software for qualitative or quantitative analysis.Results:A total of 7 randomized controlled trials were included in 5 randomized controlled trials(n=1206).The results of Meta analysis show that:(1)Clinical efficiency:there was no significant difference between intravenous immunoglobulin and plasma exchange[OR = 1.37,95%CI(0.89,2.12),P=0.16].(2)Respond time:Only one article reported the respond time,which showed no significant difference in respond time(median)of plasma immunoglobulin versus intravenous immunoglobulin[9 days vs 15 days;RR=1.67;95%CI(0.38,1.18);P = 0.14].(2)Mechanical ventilation time:there was no significant difference between intravenous immunoglobulin and plasma exchange[MD = 2.04,95%CI(-3.45,7.52),P=0.47].(3)Hospitalization time:there was no significant difference between intravenous immunoglobulin and plasma exchange[MD =-0.11,95%CI(-5.40,5.19),P=0.97].(4)Safety:intravenous immunoglobulin was better than plasma exchange[RR = 2.35,95%CI(1.65,3.36),P<0.01].Conclusion:1.For generalised myasthenia gravis,there was no difference in the efficiency,mechanical ventilation time,and hospital stay between intravenous immunoglobulin therapy and plasmapheresis therapy.2.For generalised myasthenia gravis,intravenous immunoglobulin therapy is superior to plasmapheresis therapy.