Immunoadsorption or plasma exchange in steroid‐refractory multiple sclerosis and neuromyelitis optica

Background Plasma exchange (PE) and immunoadsorption (IA) are alternative treatments of steroid‐refractory relapses of multiple sclerosis (MS) or neuromyelitis optica (NMO). Methods Adverse events and neurological follow‐ups in 127 MS‐ (62 PE, 65 IA) and 13 NMO‐ (11 PE, 2 IA) patients were retrospec...

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Bibliographic Details
Published in:Journal of clinical apheresis 2019-08, Vol.34 (4), p.381-391
Main Authors: Lipphardt, Mark, Mühlhausen, Johannes, Kitze, Bernd, Heigl, Franz, Mauch, Erich, Helms, Hans‐Joachim, Müller, Gerhard A., Koziolek, Michael J.
Format: Article
Language:English
Subjects:
Adult
Age Factors
Apheresis
Blood Component Removal
Female
Humans
immunoadsorption
Immunosorbent Techniques - adverse effects
Immunosorbent Techniques - standards
Male
Middle Aged
Multiple sclerosis
Multiple Sclerosis - therapy
Multiple Sclerosis, Relapsing-Remitting
neuromyelitis optica
Neuromyelitis Optica - therapy
Plasma
plasma exchange
Plasma Exchange - adverse effects
Plasma Exchange - standards
Prognosis
Recurrence
Retrospective Studies
Steroids - pharmacology
Steroids - therapeutic use
Time-to-Treatment
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Summary:Background Plasma exchange (PE) and immunoadsorption (IA) are alternative treatments of steroid‐refractory relapses of multiple sclerosis (MS) or neuromyelitis optica (NMO). Methods Adverse events and neurological follow‐ups in 127 MS‐ (62 PE, 65 IA) and 13 NMO‐ (11 PE, 2 IA) patients were retrospectively analyzed. Response was defined by improvements in either expanded disability status scale (EDSS) by at least 1.0 or visual acuity (VA) to 0.5, confirmed after 3 and/or 6 months. Results Hundred and forty patients were included in safety analysis, 102 patients provided sufficient neurological follow‐up‐data. There were no significant differences between IA and PE in side effects (3.9% vs 3.6%, P = .96) or response‐rate (P = .65). Responders showed significant lower age (P = .02) and earlier apheresis‐initiation (P = .01). Subgroup‐analysis confirmed significant lower age in patients with relapsing‐remitting MS (RRMS) /clinical isolated syndrome (CIS). Conclusion IA and PE seem equally safe and effective in steroid‐resistant MS‐ or NMO‐relapses. Early apheresis and low patient age are additional prognostic factors.
ISSN:0733-2459
1098-1101
DOI:10.1002/jca.21686