The use of intravenous immunoglobulin as maintenance therapy in myastheniagravis

The standard therapy for myasthenia gravis (MG) includes steroids and immun osuppressants, which have delayed onset of action and significant side effe cts. Plasmapheresis and intravenous immunoglobulin have been used mostly fo r the treatment of severe exacerbations. In the present study we examined t he use of intravenous immunoglobulin as maintenance treatment in MG. We inc luded 11 patients with generalized myasthenia gravis. All had severe bulbar and respiratory involvement that required mechanical Ventilation in three patients. Intravenous immunoglobulin treatment was initiated at a dose of 4 00 mg/kg/d for 5 days and followed by maintenance with 400 mg/kg once month ly. Regular medications were continued as necessary. There was significant improvement in all patients, and none required mechanical ventilation over the treatment period of 20.3 months +/- 8.3 (mean +/- SD, total patient yea rs of treatment = 18.7). Steroid and pyridostigmine doses were reduced sign ificantly and steroids were discontinued in two patients. There were no ser ious side effects related to intravenous immunoglobulin. These results sugg est that intravenous immunoglobulin maintenance therapy is a valid modality in patients with MG.