{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T01:38:51Z","timestamp":1788485931068,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T00:00:00Z","timestamp":1625788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Apheresis"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Despite the availability of several immunomodulatory therapies, about 20% of myasthenia gravis (MG) patients remain refractory to conventional treatments. There is limited evidence to support the use of maintenance therapeutic plasma exchange (TPE) therapy for refractory generalized MG.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective chart review of 14 patients with refractory generalized MG treated for 12\u2009months with maintenance TPE therapy. Outcome measures were myasthenia gravis composite (MGC) score, myasthenia gravis activities of daily living (MG\u2010ADL), number of acute exacerbations, medication changes, and adverse events. Data were collected at 3 monthly intervals for 12\u2009months before and after initiation of TPE therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Clinically meaningful reductions in mean MG\u2010ADL (&gt;2 points) (mean MG\u2010ADL score: 9.9\u2009\u00b1\u20090.5; 12\u2010month pre\u2010TPE to 5.2\u2009\u00b1\u20090.9; 12\u2010month post\u2010TPE) and MGC (&gt;3 points) (mean MGC score: 25.2\u2009\u00b1\u20091.6; 12\u2010month pre\u2010TPE to 11.7\u2009\u00b1\u20091.4; 12\u2010month post\u2010TPE) were observed at 3\u00a0months following initiation of TPE and were maintained up to 12\u2009months in all patients. After 12\u2009months of TPE therapy, all patients had a significant reduction in daily prednisone and pyridostigmine use. Patients previously on IVIG or rituximab therapy were successfully weaned off both treatments. There was a significant reduction in acute MG exacerbations; 7.8\u2009\u00b1\u20091.1 mean exacerbations\/patient (12\u2010month pre\u2010TPE) to 2\u2009\u00b1\u20091.1 mean exacerbations\/patient (12\u2010month post\u2010TPE).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Over a period of 12\u2009months, maintenance TPE therapy improved MG\u2010ADL, and MGC with decreased immunosuppressant requirement, while being well\u2010tolerated.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jca.21923","type":"journal-article","created":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T15:17:53Z","timestamp":1625843873000},"page":"727-736","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Clinical experience with maintenance therapeutic plasma exchange in refractory generalized myasthenia 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