Disclosures: Andrew K. Dang, BS: Nothing to disclose

Objective: Myasthenia gravis (MG) is an autoimmune neuromuscular disease caused by auto-antibodies binding to post-synaptic nicotinic acetylcholine receptors. Standard therapy for MG includes plasma exchange (PLEX), known as plasmapheresis, and intravenous immunoglobulin (IVIG). To date, neither PLEX nor IVIG has established superior clinical benefit. Chronic obstructive pulmonary disease (COPD) has significant impact on decision making among patients undergoing either type of treatment. This study aims to compare PLEX vs. IVIG in patients with concomitant COPD and MG.

Design: This retrospective cohort study utilized the Nationwide Inpatient Sample to identify patients (18+) from 2012-2015 with a primary diagnosis of MG undergoing PLEX or IVIG. ICD-9 codes identified patients with COPD and excluded patients missing identifiers (age, gender, death). Patients who received both PLEX and IVIG during the same hospitalization were excluded as combined treatment may affect outcomes. Data analyses assessed length of stay (LOS), total charges, mortality and age of admission.

Setting: Nationwide Inpatient Sample Administrative Database, 2011-2015.

Participants: Patient encounters documented in the Nationwide Inpatient Sample Administrative Database.

Interventions: Not applicable.

Main Outcome Measures: Mortality, total in-hospital charges, length of stay, age of admission.

Results: Of the 2,604 who received either PLEX or IVIG, 242 patients had concomitant COPD (127 underwent PLEX, 115 underwent IVIG). In comparison to patients who received IVIG, significant increases were observed in the PLEX group: • LOS (8.46 vs. 11.1 days, P=.018) • Total charges ($112,331.76 vs. $155,648.69, P<.0001) • Mortality (1.9% vs. 3.3%, P=.002) There were no significant differences between IVIG vs. PLEX for age of admission (67.10 vs. 66.32 years, P=.198).

Conclusions: Patients with concomitant COPD who underwent PLEX suffer from increased LOS, mortality, and total charges when compared to IVIG. The results of this study can aid clinicians in making important treatment decisions within this population. Limitations include inability to determine severity of COPD or MG. Peri-procedural optimization of symptomatic patients is one potential avenue to improve patient outcomes.

Level of Evidence: Level I

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/impact-of-chronic-obstructive-pulmonary-disease-on-short-term-in-hospital-outcomes-in-patients-with-myasthenia-gravis-undergoing-plasma-exchange-vs-intravenous-immunoglobulin-treatment/