Randomized Study of Intravenous Immunoglobulin in Patients With Mild or Moderate Myasthenia Gravis
Randomized Study of Intravenous Immunoglobulin in Patients With Mild or Moderate Myasthenia Gravis
OBJECTIVES:

 I. Determine whether intravenous immunoglobulin is an effective therapy for patients with
 mild or moderate myasthenia gravis.
PROTOCOL OUTLINE: This study is a randomized, blinded, controlled study. Patients are
 stratified in both groups according to prior thymectomy (yes vs no) and by Quantitative
 Myasthenia Gravis Score (equal to or less than 10 vs greater than 10) so that equal numbers
 are assigned to each group. Patients in group 2 are also stratified as to whether they are
 currently on azathioprine.

 Patients are randomized to receive either intravenous immunoglobulin (IVIG) for 2 days or 5%
 albumin (the placebo) for 2 days. A second infusion of IVIG for 1 day or albumin placebo for
 1 day is given on day 22.

 At the end of 6 weeks, after the randomized study, patients may choose to receive 3
 additional IVIG infusions.

 Patients are followed on days 1, 21, 32, and 42 of randomized or open label study.

 Completion date provided represents the completion date of the grant per OOPD records
PROTOCOL ENTRY CRITERIA:

 --Disease Characteristics-- Mild or moderate generalized myasthenia gravis Grade 2 or 3
 myasthenia gravis according to a modified Osserman groups system Ocular myasthenia gravis
 alone or myasthenia gravis in crisis not eligible Must have elevated acetylcholine receptor
 antibody titer No evidence of thymoma on chest CT or MRI No immunoglobulin-A deficiency
 less than 5 mg/dL Group 1: Patients who have not received other immunosuppressive therapy
 in the past, including intravenous immunoglobulin Group 2: Patients considered
 steroid-dependent

 Considered steroid-dependent if demonstrated improvement following initiation of
 corticosteroid therapy but continue to have generalized weakness on examination despite
 receiving 20 mg of prednisone (or equivalent) every other day and experience unacceptable
 symptoms on lower doses Prednisone and other immunosuppressive drug doses must not have
 changed within last 4 weeks May have had other immunosuppressive medication (azathioprine,
 cyclosporine, cyclophosphamide) or have received plasma exchange if these treatments were
 not initiated in the 2 months prior to study enrollment Must be receiving immunosuppressive
 medication for at least 3 months prior to study

 --Prior/Concurrent Therapy-- Endocrine therapy: Corticosteroid must be maintained at a
 constant dose during study Surgery: No thymectomy in the last 3 months Other: No
 plasmapheresis in the last 2 months --Patient Characteristics-- Age: 15 and over Weight: No
 greater than 80% above ideal body weight Hepatic: SGOT, SGPT, and alkaline phosphatase no
 greater than 1.5 times upper limit of normal (ULN) Renal: BUN no greater than ULN
 Creatinine no great than ULN Neurology: No history of relevant chronic degenerative,
 psychiatric, or neurologic disorder, other than myasthenia gravis, that can produce
 weakness or fatigue No altered consciousness, dementia, or abnormal mental status
 Pulmonary: Forced vital capacity at least 50% of predicted Not at high risk for aspiration
 Other: No active thyroid gland dysfunction as manifested by abnormal thyroid function tests
 or the need for current thyroid replacement Normal thyroid function tests required No other
 major relevant chronic or debilitating illnesses within 6 months of study Not pregnant or
 nursing Adequate contraception required of all fertile patients