{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T05:52:10Z","timestamp":1763617930380,"version":"3.45.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Myasthenia gravis is an autoimmune disorder characterized by muscle weakness, with myasthenic crisis representing a life-threatening exacerbation requiring respiratory support. Acute treatment options include plasmapheresis (PLEX) and intravenous immunoglobulin (IVIG). Prior studies have reported mixed results regarding the relative effectiveness of these therapies, although recent evidence suggests that PLEX may provide faster and more noticeable clinical improvement. The objective of this study was to evaluate differences in clinical and economic outcomes among U.S. patients hospitalized for myasthenia gravis or crisis who received PLEX, IVIG, both, or neither treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Myasthenia gravis and crisis admissions from 2017 to 2022 were collected using the National Inpatient Sample. Admissions were categorized by treatment: IVIG, PLEX, both, or neither. To minimize selection bias, admissions were propensity-matched for IVIG and PLEX. Differences in mortality were evaluated using logistic regression models. Length of stay and inflation-adjusted total charge were assessed using linear regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Most admissions received neither PLEX nor IVIG. Compared to treatment with neither, treatment with IVIG, PLEX, or both were not associated with significant differences in mortality; however, they were linked to longer hospital stays and higher total charge. A direct comparison of PLEX vs. IVIG revealed similar mortality and total charges, although length of stay was longer for PLEX. Older age was associated with increased mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Although PLEX has been advocated as first-line therapy due to rapid clinical improvement, national data do not clearly indicate a superior treatment option, with similar mortality and total charges observed across therapies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2025.1713388","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T05:12:28Z","timestamp":1763615548000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and economic outcomes of myasthenia gravis and myasthenic crisis when treated with PLEX and IVIG"],"prefix":"10.3389","volume":"16","author":[{"given":"Makenzie","family":"Maroney","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tabitha","family":"Diehl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eli","family":"Blaney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saif","family":"Zurob","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abubakar","family":"Tauseef","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohsin","family":"Mirza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali Bin","family":"Abdul Jabbar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2843","DOI":"10.1172\/JCI29894","article-title":"Myasthenia gravis: past, present, and future","volume":"116","author":"Conti-Fine","year":"2006","journal-title":"J Clin Invest."},{"key":"B2","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1111\/ene.12599","article-title":"Myasthenia gravis and risks for comorbidity","volume":"22","author":"Gilhus","year":"2015","journal-title":"Eur J Neurol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1002\/mus.28006","article-title":"Aishwarya, Navaratnarajah N, Cole A, Moy K. Incidence and prevalence of myasthenia gravis in the United States: a claims-based analysis","volume":"69","author":"Rodrigues","year":"2024","journal-title":"Muscle Nerve"},{"key":"B4","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1002\/mus.27832","article-title":"Myasthenic crisis","volume":"68","author":"Claytor","year":"2023","journal-title":"Muscle Nerve."},{"key":"B5","doi-asserted-by":"publisher","first-page":"874680","DOI":"10.1155\/2012\/874680","article-title":"Myasthenia gravis: a review","volume":"2012","author":"Jayam-Trouth","year":"2012","journal-title":"Autoimmune Dis."},{"key":"B6","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1212\/WNL.0000000000002790","article-title":"International consensus guidance for management of myasthenia gravis: executive summary","volume":"87","author":"Sanders","year":"2016","journal-title":"Neurology."},{"key":"B7","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1046\/j.1526-0968.2000.004004280.x","article-title":"Plasma exchange for treatment of myasthenia gravis: pathophysiologic basis and clinical experience","volume":"4","author":"Qureshi","year":"2000","journal-title":"Ther Apher."},{"key":"B8","doi-asserted-by":"publisher","first-page":"3180","DOI":"10.3390\/biomedicines11123180","article-title":"Plasma exchange versus intravenous immunoglobulin in worsening myasthenia gravis: a systematic review and meta-analysis with special attention to faster relapse control","volume":"11","author":"Pavlekovics","year":"2023","journal-title":"Biomedicines."},{"key":"B9","doi-asserted-by":"publisher","first-page":"2017","DOI":"10.1212\/WNL.0b013e31821e5505","article-title":"Comparison of IVIg and PLEX in patients with myasthenia gravis","volume":"76","author":"Barth","year":"2011","journal-title":"Neurology."},{"key":"B10","doi-asserted-by":"publisher","first-page":"e68895","DOI":"10.7759\/cureus.68895","article-title":"Comparative analysis of intravenous immunoglobulins (IVIg) vs plasmapheresis (PLEX) in the management of myasthenic crisis","volume":"16","author":"Zain","year":"2024","journal-title":"Cureus."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jocn.2024.01.025","article-title":"Assessing the comparative efficacy of plasmapheresis and intravenous immunoglobulin in myasthenia gravis treatment: a systematic review and meta-analysis","volume":"121","author":"Ghimire","year":"2024","journal-title":"J Clin Neurosci."},{"key":"B12","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1002\/ana.22139","article-title":"Comparative analysis of therapeutic options used for myasthenia gravis","volume":"68","author":"Mandawat","year":"2010","journal-title":"Ann Neurol."},{"key":"B13","unstructured":"HCUP overview. Healthcare Cost and Utilization Project User Support\n          \n          2022"},{"key":"B14","unstructured":"2025"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v042.i08","article-title":"MatchIt: nonparametric preprocessing for parametric causal inference","volume":"42","author":"Ho","year":"2011","journal-title":"J Stat Softw."},{"key":"B16","doi-asserted-by":"publisher","first-page":"499","DOI":"10.3102\/1076998609359785","article-title":"Marginal mean weighting through stratification: adjustment for selection bias in multilevel data","volume":"35","author":"Hong","year":"2010","journal-title":"J Educ Behav Stat."},{"key":"B17","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-19425-7","author":"Harrell","year":"2015","journal-title":"Regression Modeling Strategies: With Applications to Linear Models, Logistic and Ordinal Regression, and Survival Analysis"},{"key":"B18","doi-asserted-by":"publisher","first-page":"662856","DOI":"10.3389\/fneur.2021.662856","article-title":"Therapeutic plasma exchange in myasthenia gravis: a systematic literature review and meta-analysis of comparative evidence","volume":"12","author":"Ipe","year":"2021","journal-title":"Front Neurol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1212\/WNL.52.3.629","article-title":"Plasma exchange versus intravenous immunoglobulin treatment in myasthenic crisis","volume":"52","author":"Qureshi","year":"1999","journal-title":"Neurology"},{"key":"B20","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1097\/NRL.0000000000000026","article-title":"et al. IVIG versus PLEX in the treatment of worsening myasthenia gravis: what is the evidence?","volume":"19","author":"Dhawan","year":"2015","journal-title":"Neurologist."},{"key":"B21","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1097\/CND.0b013e31822c34dd","article-title":"Plasma exchange vs. intravenous immunoglobulin for myasthenia gravis crisis: an acute hospital cost comparison study","volume":"13","author":"Heatwole","year":"2011","journal-title":"J Clin Neuromuscul Dis"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e207863","DOI":"10.1212\/WNL.0000000000207863","article-title":"Hospitalizations and mortality from myasthenia gravis","volume":"102","author":"Habib","year":"2024","journal-title":"Neurology."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.1016\/S0140-6736(21)00517-1","article-title":"Kuwabara. Guillain-Barr\u00e9 syndrome","volume":"397","author":"Shahrizaila","year":"2021","journal-title":"Lancet."},{"key":"B24","doi-asserted-by":"publisher","first-page":"100772","DOI":"10.1016\/j.jtocrr.2024.100772","article-title":"Myasthenia gravis in patients treated with immune checkpoint inhibitors","volume":"6","author":"Alghabban","year":"2024","journal-title":"JTO Clin Res Rep."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1713388\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T05:12:29Z","timestamp":1763615549000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1713388\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,20]]},"references-count":24,"alternative-id":["10.3389\/fneur.2025.1713388"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1713388","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,20]]},"article-number":"1713388"}}