Plasmapheresis vs. immunoglobulin in autoimmune neurologic diseases: a meta-analysis

Ortíz Salas, Paola

doi:https://doi.org/10.48713/10336_5705

Ítem

Acceso Abierto

Plasmapheresis vs. immunoglobulin in autoimmune neurologic diseases: a meta-analysis

http://repository.urosario.edu.co/handle/10336/5705
https://doi.org/10.48713/10336_5705

Autores

Ortíz Salas, Paola

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Fecha

2014-06-05

Directores

Vélez van Meerbeke, Alberto Francisco

Editor

Universidad del Rosario

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Abstract

Objectives: to evaluate the efficacy and safety of human immunoglobulin versus plasmapheresis in the management of autoimmune neurologic diseases. Likewise, length of hospital stay and duration of ventilator support were compared. Methods: Randomized controlled trials and analytical observational studies of more than 10 cases, were reviewed. Cochrane Neuromuscular Disease Group trials, MEDLINE, EMBASE, HINARI Ovid, the Database of abstracts of reviews of effectiveness and the Economic evaluation Database were searched as data source. Reference lists were examined for further relevant articles. A random-effect model was used to derive a pooled risk ratio. Results: 725 articles were found and 27 met the criteria for a population studied of 4717 cases: 14 articles were about Guillain Barré syndrome, 10 of Myasthenia Gravis, one of Sydenham Chorea, one of Chronic inflammatory demyelinating polyneuropathy, and one of PANDAS. No evidence was found in favor of any of the two treatments as regards effectiveness (OR 0. 94, IC 0. 63 – 1. 41, p= 0. 77) or ventilator support time; IGIV had a significant better safety profile than plasmapheresis (OR 0. 70, IC 0. 51 – 0. 96, p= 0. 03) and patients needed less time of hospital stay (p=0. 03). Conclusions: There is no evidence for superiority in the effectiveness of immunoglobulin or plasmapheresis in the management of autoimmune neurologic diseases. Nevertheless, patients treated with immunoglobulin have statistically significant less adverse effects, a shorter hospital stay and a tendency of less ventilator support time. These premises could lead to fewer costs for health services but an economic study should be done.