Therapeutic plasma exchange in MS refractory relapses: Long-term outcome

• Published in: Multiple sclerosis and related disorders 2021-10, Vol.55, p.103168-103168, Article 103168
• Main Authors: Marrodan, M., Crema, S., Rubstein, A., Alessandro, L., Fernandez, J., Correale, J., Ysrraelit, M.C.
• Format: Article
• Language: English
• Subjects: Multiple sclerosis; Relapses; Therapeutic plasma-exchange
• ISSN: 2211-0348; 2211-0356
• DOI: 10.1016/j.msard.2021.103168

•TPE decreases long-term disability in RRMS patients with IVMPS-refractory relapses.•First study assessing disability at 24 months in RRMS patients treated with TPE.•Novel information about MS patients in LATAM is provided. Therapeutic plasma exchange (TPE) is considered a treatment option for steroid-refractory multiple sclerosis (MS) relapses. Our objective was to assess long-term clinical response to TPE in MS steroid-refractory exacerbations. Retrospective study of relapsing remitting MS (RRMS) patients presenting intravenous methylprednisolone (IVMPS)-refractory relapses, who underwent TPE. Response to TPE was assessed at 1, 3, 6, 12 and 24-months post-treatment, and compared to a second group of RRMS patients with similar demographic and clinical characteristics presenting, IVMPS-refractory relapses but not treated with TPE. Multivariate regression analysis was used to assess potential predictors of significant clinical response. Between 2011 to 2020, a total of 23 RRMS patients were treated with TPE. Twenty-one patients not receiving the treatment served as controls. No differences in demographic or clinical characteristics, or predictors of clinical improvement after TPE were detected between groups. Seventy-eight percent of patients treated with TPE presented clinical improvement at 24 months. TPE-treated patients presented lower EDSS scores at 6 and at 24 months. Younger age, presence of gadolinium-enhancing lesions and TPE treatment were associated with better clinical outcomes. No life-threatening side effects were reported. TPE is a safe and well tolerated procedure that decreases long-term disability in RRMS patients with IVMPS-refractory relapses.