M PLASMAPHARESIS V MAB

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Here’s a clear table comparing rituximab vs plasmapheresis in internal medicine autoimmune and antibody-mediated diseases:

Condition	Preferred / First-line Therapy	Role of Plasmapheresis	Role of Rituximab
ANCA-associated vasculitis	Immunosuppressants (cyclophosphamide or rituximab)	Rarely used except in severe renal involvement	Often first-line instead of cyclophosphamide for induction
Myasthenia gravis (non-crisis)	Acetylcholinesterase inhibitors, immunosuppressants	Rare	Rituximab for refractory disease
Myasthenia gravis (crisis)	ICU support, steroids	First-line for rapid antibody removal	Not immediate; may prevent future relapses
Immune thrombocytopenia (ITP)	Steroids, IVIG	Rare	Rituximab for steroid-refractory cases
Pemphigus vulgaris	Steroids	Rare	Rituximab is increasingly first-line for moderate/severe cases
Thrombotic thrombocytopenic purpura (TTP)	Plasma exchange	First-line to remove ADAMTS13 autoantibodies	Adjunct, reduces relapses
Anti-GBM disease (Goodpasture’s)	Plasmapheresis + steroids + immunosuppressants	First-line to remove antibodies	May be used as adjunct if refractory
Lupus nephritis (class III/IV)	Steroids + immunosuppressants	Occasionally for severe refractory cases	Rituximab for refractory lupus nephritis

Key takeaway:

• Rituximab has mostly replaced plasmapheresis in chronic management of autoimmune diseases mediated by B cells/autoantibodies, especially when slower, sustained immunosuppression is acceptable.

• Plasmapheresis remains essential for acute, life-threatening situations where rapid removal of pathogenic antibodies is critical.

If you want, I can also make a mnemonic to remember which diseases rituximab replaced plasmapheresis in, which is very handy for exams. Do you want me to make that?