Introduction: Myasthenia Crisis is the most severe form of Myasthenia gravis which is marked by abrupt respiratory failure that needs rapid treatment and immunomodulator therapy. Although Plasma Exchange and Intravenous Immunoglobulin (IVIG) therapies are recommended, we are not sure which is superior to another and this can cause global practice inconsistency. This meta analysis was done to synthesize existing evidence and clarify which is better in myasthenia crisis Methods: A systematic search of PubMed, Embase, Google Scholar and Cochrane databases was conducted to find studies that compare plasma Exchange to IVIG. Four studies met inclusion criteria. Data were pooled using inverse variance weighting with a random-effects model in R Studio. Forest plots were used to illustrate pooled effect estimates, and heterogeneity was assesed Results: A total of 3901 myasthenia crisis cases from 4 studies were included, where they were treated with either plasma exchange or IVIG. IVIG showed significantly less mortality compared to plasma exchange (RR 0.50; 95% CI: 0.26, 0.97; p=0.039). Duration of intubation was slightly shorter with plasma exchange but is not statistically significant (MD -2.66; 95% CI: -9.23, 3.91; p=0.43). Also there is no difference observed for length of stay between plasma exchange and IVIG (MD -0.26; 95% CI: -10.36, 9.85; p=0.96). Conclusions: IVIG showed lower mortality in myasthenia crisis, but length of intubation and length of hospital stay were comparable between IVIG and plasma exchange. Future research should focus on refining ICU protocols, exploring sequential/combination therapy, and stratify outcomes based on MG Serotype, age and comorbidities to personalize the treatment protocols
Krishnamaneni et al. (Sun,) studied this question.