Download PDF
Aktuelle Neurologie 2010; 37(10): 518-523
DOI: 10.1055/s-0030-1265985
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Immuntherapie bei Myasthenia gravis und Lambert-Eaton-Syndrom

Teil 2: Intravenöse Immunglobuline und PlasmaaustauschverfahrenImmunotherapy for Myasthenia Gravis and Lambert-Eaton Myasthenic SyndromePart 2: Intravenous Immunoglobulins and Apheresis TechniquesT.  Henze1 , R.  W. C.  Janzen2 , F.  Schumm3 , A.  Melms4 , J.  P.  Sieb5 , W.  Köhler6 , F.  Heidenreich7 , B.  Tackenberg8 für den Ärztlichen Beirat der Deutschen Myasthenie-Gesellschaft (DMG) C.  Weber-Schöndorfer9
  • 1Reha-Zentrum Nittenau, Nittenau
  • 2Bad Homburg
  • 3Neurologische Klinik Christophsbad, Göppingen
  • 4Neurologische Universitätsklinik Tübingen
  • 5Neurologische Klinik, Klinikum Stralsund
  • 6Fachkrankenhaus Hubertusburg, Neurologische Klinik, Wermsdorf
  • 7Neurologische Klinik, Henriettenstift Hannover
  • 8Neurologische Universitätsklinik Marburg
  • 9Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie, Berlin
Further Information

Publication History

Publication Date:
05 January 2011 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die intravenöse Gabe hoch dosierter Immunglobuline stellt ebenso wie der Plasmaaustausch und die (semi)selektive Immunadsorption eine wichtige Behandlungsoption bei myasthenen Krisen bzw. Exazerbationen sowie auch bei der Behandlung schwerster chronischer Myasthenien dar. Die genannten Verfahren sind damit wichtiger Bestandteil des Therapiekonzepts myasthener Syndrome und ergänzen die in der vorhergehenden Publikation dargestellten medikamentösen Behandlungsmöglichkeiten. In der vorliegenden Publikation geht der Ärztliche Beirat der Myasthenie-Gesellschaft (DMG) auf die Indikationen, Studienergebnisse und Komplikationsmöglichkeiten der genannten Verfahren sowie ihren Stellenwert ein.

Abstract

Intravenous immunoglobulins (IVIG), plasma exchange and semi-selective immunoadsorption represent important options for the treatment of myasthenic crisis or its exacerbations as well as severe chronic myasthenia gravis. They are therefore indispensable components of a comprehensive treatment concept for myasthenic syndromes and complete individual drug treatment which has been discussed in the preceding part of this review. In this publication, the Advisory Board of the German Myasthenia Society (DMG) discusses the indications, study results, adverse events and complications of IVIG, plasma exchange and immunoadsorption and their importance within the treatment concept.

Schlüsselwörter

Myasthenia gravis - Lambert-Eaton myasthenes Syndrom - Immuntherapie - Immunglobuline - Aphereseverfahren

Keywords

myasthenia gravis - Lambert-Eaton myasthenic syndrome - immunotherapy - immunoglobulins - apheresis techniques

Literatur

  • 1 NIH consensus conference. Intravenous immunoglobulin. Prevention and treatment of disease.  JAMA. 1990;  264 3189-3193
    CrossrefPubMedGoogle Scholar
  • 2 Dalakas M C. Mechanisms of action of IVIg and therapeutic considerations in the treatment of acute and chronic demyelinating neuropathies.  Neurology. 2002;  59 S13-21
    CrossrefPubMedGoogle Scholar
  • 3 Tackenberg B, Jelcic I, Baerenwaldt A et al. Impaired inhibitory FCγ receptor IIB expression on B cells in CIDP.  Proc Ntl Acad Sci USA. 2009;  106 4788-4792
    PubMedGoogle Scholar
  • 4 Stangel M, Gold R. Einsatz intravenöser Immunglobuline in der Neurologie. Ein evidenzbasierter Konsens: Update 2010.  Nervenarzt. 2010;  Doi DOI: 10.1007/s00115-010-3059-8
    Google Scholar
  • 5 Zinman L, Ng E, Bril V. IV immunoglobulin in patients with myasthenia gravis: a randomized controlled trial.  Neurology. 2007;  68 837-841
    CrossrefPubMedGoogle Scholar
  • 6 Gajdos P, Tranchant C, Clair B Myasthenia Gravis Clinical Study Group et al. Treatment of myasthenia gravis exacerbation with intravenous immunoglobulin: a randomized double-blind clinical trial.  Arch Neurol. 2005;  62 1689-1693
    CrossrefPubMedGoogle Scholar
  • 7 Gajdos P, Chevret S, Toyka K. Intravenous immunoglobulin for myasthenia gravis.  Cochrane Database Syst Rev. 2008;  CD002277
    PubMedGoogle Scholar
  • 8 Rønager J, Ravnborg M, Hermansen I et al. Immunoglobulin treatment versus plasma exchange in patients with chronic moderate to severe myasthenia gravis.  Artif Organs. 2001;  25 967-973
    CrossrefPubMedGoogle Scholar
  • 9 Gajdos P, Chevret S, Clair B Myasthenia Gravis Clinical Study Group et al. Clinical trial of plasma exchange and high-dose intravenous immunoglobulin in myasthenia gravis.  Ann Neurol. 1997;  41 789-796
    CrossrefPubMedGoogle Scholar
  • 10 Wolfe G I, Barohn R J, Foster B M Myasthenia Gravis-IVIG Study Group et al. Randomized, controlled trial of intravenous immunoglobulin in myasthenia gravis.  Muscle Nerve. 2002;  26 549-552
    CrossrefPubMedGoogle Scholar
  • 11 Qureshi A I, Choudhry M A, Akbar M S et al. Plasma exchange versus intravenous immunoglobulin treatment in myasthenic crisis.  Neurology. 1999;  52 629-632
    CrossrefPubMedGoogle Scholar
  • 12 Seneviratne J, Mandrekar J, Wijdicks E F et al. Predictors of extubation failure in myasthenic crisis.  Arch Neurol. 2008;  65 929-933
    CrossrefPubMedGoogle Scholar
  • 13 Thomas C E, Mayer S A, Gungor Y et al. Myasthenic crisis: clinical features, mortality, complications, and risk factors for prolonged intubation.  Neurology. 1997;  48 1253-1260
    CrossrefPubMedGoogle Scholar
  • 14 Tatay J, Díez-Tejedor E, Frank A et al. Association of plasmapheresis and high doses of intravenous immunoglobulins in the treatment of myasthenia gravis.  Rev Neurol. 1997;  25 1402-1406
    PubMedGoogle Scholar
  • 15 Stricker R B, Kwiatkowska B J, Habis J A et al. Myasthenic crisis. Response to plasmapheresis following failure of intravenous gamma-globulin.  Arch Neurol. 1993;  50 837-840
    CrossrefPubMedGoogle Scholar
  • 16 Wegner B, Ahmed I. Intravenous immunoglobulin monotherapy in long-term treatment of myasthenia gravis.  Clin Neurol Neurosurg. 2002;  105 3-8
    CrossrefPubMedGoogle Scholar
  • 17 Achiron A, Barak Y, Miron S et al. Immunoglobulin treatment in refractory myasthenia gravis.  Muscle Nerve. 2000;  23 551-555
    CrossrefPubMedGoogle Scholar
  • 18 Hilkevich O, Drory V E, Chapman J et al. The use of intravenous immunoglobulin as maintenance therapy in myasthenia gravis.  Clin Neuropharmacol. 2001;  24 173-176
    CrossrefPubMedGoogle Scholar
  • 19 Shibata-Hamaguchi A, Samuraki M, Furui E et al. Long-term effect of intravenous immunoglobulin on anti-MuSK antibody-positive myasthenia gravis.  Acta Neurol Scand. 2007;  116 406-408
    CrossrefPubMedGoogle Scholar
  • 20 Saulat B, Maertens P, Hamilton W J et al. Anti-musk antibody after thymectomy in a previously seropositive myasthenic child.  Neurology. 2007;  69 803-804
    CrossrefPubMedGoogle Scholar
  • 21 Takahashi H, Kawaguchi N, Nemoto Y et al. High-dose intravenous immunoglobulin for the treatment of MuSK antibody-positive seronegative myasthenia gravis.  J Neurol Sci. 2006;  247 239-241
    CrossrefPubMedGoogle Scholar
  • 22 Evoli A, Tonali P A, Padua L et al. Clinical correlates with anti-MuSK antibodies in generalized seronegative myasthenia gravis.  Brain. 2003;  126 2304-2311
    CrossrefPubMedGoogle Scholar
  • 23 Lebrun C, Bourg V, Tieulie N et al. Successful treatment of refractory generalized myasthenia gravis with rituximab.  Eur J Neurol. 2009;  16 246-250
    CrossrefPubMedGoogle Scholar
  • 24 Hain B, Jordan K, Deschauer M et al. Successful treatment of MuSK antibody-positive myasthenia gravis with rituximab.  Muscle Nerve. 2006;  33 575-580
    CrossrefPubMedGoogle Scholar
  • 25 Bain P G, Motomura M, Newsom-Davis J et al. Effects of intravenous immunoglobulin on muscle weakness and calcium-channel autoantibodies in the Lambert-Eaton myasthenic syndrome.  Neurology. 1996;  47 678-683
    PubMedGoogle Scholar
  • 26 Tim R W, Massey J M, Sanders D B. Lambert-Eaton myasthenic syndrome (LEMS). Clinical and electrodiagnostic features and response to therapy in 59 patients.  Ann N Y Acad Sci. 1998;  841 823-826
    CrossrefPubMedGoogle Scholar
  • 27 Rich M M, Teener J W, Bird S J. Treatment of Lambert-Eaton syndrome with intravenous immunoglobulin.  Muscle Nerve. 1997;  20 614-615
    CrossrefPubMedGoogle Scholar
  • 28 Tackenberg B, Hemmer B, Oertel W H et al. Immunosuppressive treatment of ocular myasthenia gravis.  BioDrugs. 2001;  15 369-378
    CrossrefPubMedGoogle Scholar
  • 29 Toyka K V, Drachman D B, Griffin D E et al. Myasthenia gravis. Study of humoral immune mechanisms by passive transfer to mice.  N Engl J Med. 1977;  296 125-131
    CrossrefPubMedGoogle Scholar
  • 30 Pinching A J, Peters D K, Newsom-Davis J. Plasma exchange in myasthenia gravis.  Lancet. 1977;  309 428-429
    PubMedGoogle Scholar
  • 31 Bucka C, Köhler W, Hertel G et al. Immunadsorption bei Myasthenia gravis. Wirkungsweise, immunologische Parameter und klinischer Verlauf.  Akt Neurol. 1993;  20 207-213
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Goto H, Matsuo H, Nakane S et al. Plasmapheresis affects T helper type-1 / T helper type-2 balance of circulating peripheral lymphocytes.  Ther Apher. 2001;  5 494-496
    PubMedGoogle Scholar
  • 33 Ptak J, Lochmann J. Immunoadsorption and complement activation.  Transfus Apher Sci. 2005;  32 263-267
    CrossrefPubMedGoogle Scholar
  • 34 Yeh J H, Wang S H, Chien P J et al. Changes in serum cytokine levels during plasmapheresis in patients with myasthenia gravis.  Eur J Neurol. 2009;  16 1318-1322
    CrossrefPubMedGoogle Scholar
  • 35 Lehmann H C, Hartung H P, Hetzel G R et al. Plasma exchange in neuroimmunological disorders: Part 2. Treatment of neuromuscular disorders.  Arch Neurol. 2006;  63 1066-1071
    CrossrefPubMedGoogle Scholar
  • 36 Gold R, Schneider-Gold C. Current and future standards in treatment of myasthenia gravis.  Neurotherapeutics. 2008a;  5 535-541
    CrossrefPubMedGoogle Scholar
  • 37 Wagner S, Grützmacher W. Langzeitbehandlung der therapierefraktären Myasthenia gravis mittels therapeutischer Apherese.  Nephro-News. 2007;  No. 9 31
    PubMedGoogle Scholar
  • 38 Triantafyllou N I, Grapsa E I, Karaziou E et al. Periodic therapeutic plasma exchange in patients with moderate to severe chronic myasthenia gravis non-responsive to immunosuppressive agents: an eight year follow-up.  Ther Apher Dial. 2009;  13 174-178
    CrossrefPubMedGoogle Scholar
  • 39 Winters J L, Pineda A A. New directions in plasma exchange.  Curr Opin Hematol. 2003;  10 424-428
    CrossrefPubMedGoogle Scholar
  • 40 Assessment of plasmapheresis: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.  Neurology. 1996;  47 840-843
    PubMedGoogle Scholar
  • 41 National Institutes of Health Consensus Development Conference . The use of therapeutic plasmapheresis for neurological disorders.  Transfus Med Rev. 1988;  2 48-53
    CrossrefPubMedGoogle Scholar
  • 42 Gajdos P, Chevret S, Toyka K. Plasma exchange for myasthenia gravis.  Cochrane Database Syst Rev. 2002;  CD002275
    PubMedGoogle Scholar
  • 43 Newsom-Davis J, Wilson S G, Vincent A et al. Long-term effects of repeated plasma exchange in myasthenia gravis.  Lancet. 1979;  1 464-468
    PubMedGoogle Scholar
  • 44 Sutton D M, Nair R C, Rock G. Complications of plasma exchange.  Transfusion. 1989;  29 124-127
    CrossrefPubMedGoogle Scholar
  • 45 Köhler W, Kalischewski P, Bucka C et al. Immunoadsorption versus plasma exchange: A randomized clinical trial in Myasthenia Gravis.  Kidney Blood Pressure Res. 2000;  23 214-347
    PubMedGoogle Scholar
  • 46 Zisimopoulou P, Lagoumintzis G, Poulas K et al. Antigen-specific apheresis of human anti-acetylcholine receptor autoantibodies from myasthenia gravis patients’ sera using Escherichia coli-expressed receptor domains.  J Neuroimmunol. 2008;  200 133-141
    CrossrefPubMedGoogle Scholar
  • 47 Skeie G O, Apostolski S, Evoli A et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders.  Eur J Neurol. 2010;  17 893-902
    CrossrefPubMedGoogle Scholar
  • 48 Haupt W F, Rosenow F, van der Ven C et al. Immunoadsorption in Guillain-Barré syndrome and Myasthenia Gravis.  Therapeutic Apheresis. 2000;  4 195-197
    PubMedGoogle Scholar
  • 49 Haupt F W, Klingel R. Indications for therapeutic apheresis in neurologic diseases.  Kidney Blood Pressure Research. 2001;  24 418-421
    PubMedGoogle Scholar
  • 50 Marx C, Marx M, Endler S et al. Safe and effective long-term outpatient immunoadsorption (IA) in a patient with severe Myasthenia Gravis (Ossermann IV).  Kidney Blood Pressure Res. 2000;  23 214-347 (abstract)
    PubMedGoogle Scholar
  • 51 Wagner S, Janzen R WC, Mohs C et al. Langzeitbehandlung der therapierefraktären Myasthenia gravis mittels Immunadsorption.  Dtsch Med Wschr. 2008;  133 2377-2382
    Article in Thieme ConnectPubMedGoogle Scholar
  • 52 Zeitler H, Ulrich-Merzenich G, Hoffmann L et al. Long-term effects of a multimodal approach including immunoadsorption for the treatment of myasthenic crisis.  Artif Organs. 2006;  30 597-605
    CrossrefPubMedGoogle Scholar
  • 53 Antozzi C, Berta E, Confalonieri P et al. Protein-A immunoadsorption in immunosuppression-resistant myasthenia gravis.  Lancet. 1994;  343 124
    CrossrefPubMedGoogle Scholar
  • 54 Benny W B, Sutton D M, Oger J et al. Clinical evaluation of a staphylococcal protein A immunoadsorption system in the treatment of myasthenia gravis patients.  Transfusion. 1999;  39 682-687
    CrossrefPubMedGoogle Scholar
  • 55 Grob D, Simpson D, Mitsumoto H et al. Treatment of myasthenia gravis by immunoadsorption of plasma.  Neurology. 1995;  45 338-344
    CrossrefPubMedGoogle Scholar
  • 56 Gold R, Krenzer M, Klinker E et al. Efficacy and Safety of Immunoadsorption vs Plasmapheresis vs Combination for Treatment of Myasthenic Crisis: Comparative Retrospective Study on 72 Patients. Abstract S57.002 und Vortrag at 60th Annual Meeting American Academy of Neurology Chicago; 2008b
    Google Scholar
  • 57 Hosokawa S, Oyamaguchi A. Safety, stability, and effectiveness of immunoadsorption under membrane plasmapheresis treatment for myasthenia gravis.  ASAIO Trans. 1990;  36 M207-208
    PubMedGoogle Scholar
  • 58 Ishizeki J, Nishikawa K, Kunimoto F et al. Postoperative myasthenic crisis successfully treated with immunoadsorption therapy.  J Anaesth. 2005;  19 320-322
    PubMedGoogle Scholar
  • 59 Sato T, Ishigaki Y, Komiya T et al. Therapeutic immunoadsorption of acetylcholine receptor antibodies in myasthenia gravis.  Ann N Y Acad Sci. 1988;  540 554-556
    CrossrefPubMedGoogle Scholar
  • 60 Shibuya N, Sato T, Osame M et al. Immunoadsorption therapy for myasthenia gravis.  J Neurol Neurosurg Psychiatry. 1994;  57 578-581
    CrossrefPubMedGoogle Scholar
  • 61 Szpirt W, Somnier F, Nielsen F C et al. Elimination of IgG subclasses of anti-acetylcholine receptor antibodies in myasthenic plasma by immunoadsorption to protein A.  Life Support Syst. 1985;  3 (S 01) 351-355
    PubMedGoogle Scholar
  • 62 Ichikawa M, Koh C S, Hata Y et al. Immunoadsorption plasmapheresis for severe generalized myasthenia gravis.  Arch Child Dis. 1993;  69 236-238
    PubMedGoogle Scholar
  • 63 Besinger U A, Toyka K V, Hömberg M et al. Myasthenia gravis: Long-term correlation of binding and bungarotoxin blocking antibodies against acetylcholine receptors with changes in disease severity.  Neurology. 1983;  33 1316-1321
    CrossrefPubMedGoogle Scholar
  • 64 Yeh J H, Chiu H C. Immunoadsorption therapy for myasthenia gravis: study on the adsorption capacity of an immunoadsorption column.  J Microbiol Immunol Infect. 1999a;  32 121-125
    PubMedGoogle Scholar
  • 65 Yeh J H, Chiu H C. Comparison between double-filtration plasmapheresis and immunoadsorption plasmapheresis in the treatment of patients with myasthenia gravis.  J Neurol. 2000;  247 510-513
    CrossrefPubMedGoogle Scholar
  • 66 Haas M, Mayr N, Zeitlhofer J et al. Long-term treatment of Myasthenia gravis with immunoadsorption.  J Clin Apheresis. 2002;  17 84-87
    CrossrefPubMedGoogle Scholar
  • 67 Ishikawa S, Takei Y, Tokunaga S et al. Response to immunoadsorption and steroid therapy in a patient with carcinomatous Lambert-Eaton myasthenia syndrome accompagnied by disturbed consciousness.  Rinsho Skinkeigaku. 2000;  40 459-463
    PubMedGoogle Scholar
  • 68 Berta E, Confalonieri P, Simoncini O et al. Removal of antiacetylcholine receptor antibodies by protein-A immunoadsorption in myasthenia gravis.  Int J Artif Organs. 1994;  17 603-608
    PubMedGoogle Scholar
  • 69 Yeh J H, Chiu H C. Optimal volume of processed plasma and total number of selective plasmapheresis sessions in the treatment of patients with severe generalized myasthenia gravis.  J Clin Apher. 1999b;  14 177-180
    CrossrefPubMedGoogle Scholar

Prof. Dr. med. Thomas Henze

Reha-Zentrum Nittenau

Eichendorffstr. 21

93149 Nittenau

Email: t.henze@rz-ni.de