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. This study aims to compare PLEX vs. IVIG in patients with concomitant DM 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 DM 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 patients receiving either PLEX or IVIG, 627 had DM without complications (340 underwent PLEX, 287 underwent IVIG), and 147 had DM with complications (92 underwent PLEX, 55 underwent IVIG). In comparison to patients who received IVIG, significant increases were observed in the PLEX group: DM without complications: • LOS (7.53 vs. 10.1 days, P<.0001). • Mortality (2.5% vs. 4.3%, P<.0001). • Total charges ($100,491.21 vs. 111,011.29, P=.03). DM with complications: • LOS (6.50 vs. 9.15 days, P=.0012). • Mortality (3.3% vs. 5.9%, P<.0001). • Total charges ($91,022.63 vs. $110,067.50, P<.0001). No significant differences between IVIG vs. PLEX for age of admission in both DM patients with and without complications.

Conclusions: Patients with concomitant DM undergoing PLEX suffer from increased LOS, mortality, and total charges when compared to IVIG. Results of this study can aid clinicians in making treatment decisions within this population. 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-diabetes-mellitus-on-short-term-in-hospital-outcomes-in-patients-with-myasthenia-gravis-undergoing-plasma-exchange-vs-intravenous-immunoglobulin-treatment/