Abstract Details

Title 12-year trend in utilization of IVIG and plasmapheresis following acute myasthenia exacerbation and myasthenic crisis in the United States and their association with outcome.

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 11-001

Objective

(1) Evaluate trends in intravenous immunoglobin (IVIG) and plasmapheresis use following acute myasthenia exacerbation (AME) and manifest myasthenic crisis (MMC) hospitalization in the United States (US). 2) Study the association of PLEX and IVIG use with trends in outcome following AME/MMC.

Background NA

Design/Methods All adult admissions with AME were identified from the 2007-2018 National Inpatient Sample. MMC was defined as AME requiring intubation. Joinpoint and multivariable models were used to trend, determine predictors and study the association of treatment with mortality or home disposition.

Results Of all AME hospitalizations (weighted N=103,667) across this period, 27.8% were MMC. 35.7% of AME received any-treatment [IVIG:15.2%; PLEX:21.8%], but only 30.7% of MMC received any-treatment (IVIG: 10.7%; PLEX 22.5%). On joinpoint regression, IVIG use in AME increased by 5.0% (p=0.001) per year but PLEX use remained unchanged [ -0.77% (p=0.269)]. In MMC, both IVIG [9.6% (p<0.001)] and PLEX use [5.0% (p=0.007)] increased annually. In multivariable models, odds of any-treatment declined with age in both AME and MMC (MMC 60-79yo vs 18-39yo, OR:0.59, 95%CI 0.45-0.77) but there was no sex difference in usage. Overall in-hospital mortality in MMC was 16.6% but this declined from 20.7% in 2009 to 9.4% in 2018. Compared to no-treatment, IVIG or PLEX use were associated with >50% reduced odds of in-hospital mortality in both AME and MMC (MMC; IVIG-vs-no-treatment OR 0.35, 95%CI 0.23-0.54, PLEX-vs-no-treatment OR 0.45, 95%CI 0.35-0.58). Both treatments were also associated with increased odds of home discharge (MMC: IVIG-vs-no-treatment OR 1.58, 95%CI 1.19-2.10, PLEX-vs-no-treatment 1.39, 95%CI 1.15-1.69)

Conclusions IVIG or PLEX use in AME and MMC increased over the last decade, but despite very strong association with decreased mortality and greater odds of home discharge, both procedures are still very underutilized in the US. Core AME/MMC treatment measures that incorporate these modalities are needed to reduce mortality.

Authors/Disclosures
Bhavya Narapureddy, MBBS (Upstate Medical University) PRESENTER	Dr. Narapureddy has nothing to disclose.
Ahmed Ibrahim, MBBCH (Mayo Clinic)	Dr. Ibrahim has nothing to disclose.
Julius Latorre, MD, FAAN (SUNY Upstate Med Univ Hosp/Neuro)	Dr. Latorre has nothing to disclose.
Fadar O. Otite, MD (SUNY Upstate Medical University)	Dr. Otite has nothing to disclose.

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