Efficacy of plasma exchange in acute attacks of neuromyelitis optica spectrum disorders: A systematic review and meta-analysis

Yu, Haihan; Qin, Chuan; Zhang, Shuo-Qi; Chen, Bin; Ma, Xue; Tao, Ran; Chen, Man; Chu, Yun-Hui; Bu, Bitao; Tian, Dai-Shi

doi:10.1016/j.jneuroim.2020.577449

Cited by 12 publications

(20 citation statements)

References 36 publications

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“…We also compared the efficacy of different treatment options, but no significant difference was found. Although studies ascertained the importance of PE as a therapeutic intervention in acute attacks (10,26), PE was not associated with an additional curative effect when compared to IVMP alone in our trial. These might be due to the limited number of cases in some treatment options and/or possible baseline differences between distinct subgroups, an inherited disadvantage of an observational study design.…”

Section: Discussionmentioning

confidence: 60%

Therapeutic Response and Possible Biomarkers in Acute Attacks of Neuromyelitis Optica Spectrum Disorders: A Prospective Observational Study

Wang

Chu

et al. 2021

Front. Immunol.

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ObjectiveTo explore the outcomes of NMOSD attacks and investigate serum biomarkers for prognosis and severity.MethodPatients with NMOSD attacks were prospectively and observationally enrolled from January 2019 to December 2020 at four hospitals in Guangzhou, southern China. Data were collected at attack, discharge and 1/3/6 months after acute treatment. Serum cytokine/chemokine and neurofilament light chain (NfL) levels were examined at the onset stage.ResultsOne hundred patients with NMOSD attacks were included. The treatment comprised intravenous methylprednisolone pulse therapy alone (IVMP, 71%), IVMP combined with apheresis (8%), IVMP combined with intravenous immunoglobulin (18%) and other therapies (3%). EDSS scores decreased significantly from a medium of 4 (interquartile range 3.0–5.5) at attack to 3.5 (3.0–4.5) at discharge, 3.5 (2.0–4.0) at the 1-month visit and 3.0 (2.0–4.0) at the 3-month visit (p<0.01 in all comparisons). The remission rate was 38.0% at discharge and 63.3% at the 1-month visit. Notably, relapse occurred in 12.2% of 74 patients by the 6-month follow-up. Higher levels of T helper cell 2 (Th2)-related cytokines, including interleukin (IL)-4, IL-10, IL-13, and IL-1 receptor antagonist, predicted remission at the 1-month visit (OR=9.33, p=0.04). Serum NfL levels correlated positively with onset EDSS scores in acute-phase NMOSD (p<0.001, R2 = 0.487).ConclusionsOutcomes of NMOSD attacks were generally moderate. A high level of serum Th2-related cytokines predicted remission at the 1-month visit, and serum NfL may serve as a biomarker of disease severity at attack.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT04101058, identifier NCT04101058.

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Section: Discussionmentioning

confidence: 60%

Therapeutic Response and Possible Biomarkers in Acute Attacks of Neuromyelitis Optica Spectrum Disorders: A Prospective Observational Study

Wang

Chu

et al. 2021

Front. Immunol.

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“…Through evaluating the function of mLVs, DCE-MRI will provide objective evidence to predict the relapse of NMOSD. The exact diagnosis is of great significance for the timely treatment and prevention of disease progression, as patients with NMOSD relapses require timely immunomodulatory therapy, including high-dose steroids ( 44 , 45 ), IV immunoglobulin (IVIg) therapy ( 45 , 46 ) and plasma exchange ( 44 , 47 , 48 ) in the acute phase. In this study, the DCE-MRI parameters, especially the TTP values of L-mLVs-SSS, R-mLVs-SSS, and L+R-mLVs-SSS, had the capacity to distinguished ANMOSD patients from CNMOSD patients with high accuracy, high sensitivity and specificity.…”

Section: Discussionmentioning

confidence: 99%

Impaired Meningeal Lymphatic Flow in NMOSD Patients With Acute Attack

et al. 2021

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The meningeal lymphatic vessels (mLVs) in central nervous system (CNS) have been validated by rodent and human studies. The mLVs play a vital role in draining soluble molecules and trafficking lymphocytes, antigens and antibodies from CNS into cervical lymph nodes (CLNs). This indicates that mLVs may serve as a link between the CNS and peripheral immune system, perhaps involving in the neuroinflammatory disease. However, the morphology and drainage function of mLVs in patients with neuroinflammatory disease, such as neuromyelitis optica spectrum disorders (NMOSD), remains unexplored. Using the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), we found that slower flow through mLVs along superior sagittal sinus in NMOSD patients with acute attack instead of NMOSD patients in chronic phase. The reduced flow in mLVs correlated with the disease severity evaluated by expanded disability status scale (EDSS). The receiver operating characteristic curve (ROC) indicated DCE-MRI might provide objective evidence to predict the acute relapse of NMOSD through evaluating the function of mLVs. Promoting or restoring the function of mLVs might be a new target for the treatment of NMOSD relapse.

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“…Other studies have shown the efficacy of PLEX as an add-on treatment to IVMP to reduce disability in severe spinal attacks [64] and to improve visual acuity in optic neuritis [65,66] in NMOSD, compared with the use of IVMP as the only treatment. There is also plausible evidence that an earlier initiation of PLEX is associated with a better response and functional outcome [48,51,56,67,68]. In summary, PLEX should be started early in patients who show suboptimal improve-ment with IVMP, and concomitant use of IVMP and PLEX may be considered as an initial treatment in severe attacks of NMOSD.…”

Section: Treatments For Acute Attacks Of Nmosdmentioning

confidence: 99%

Treatment of Neuromyelitis Optica Spectrum Disorders

Chan

Lee

2021

IJMS

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Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune central nervous system (CNS) inflammatory disorder that can lead to serious disability and mortality. Females are predominantly affected, including those within the reproductive age. Most patients develop relapsing attacks of optic neuritis; longitudinally extensive transverse myelitis; and encephalitis, especially brainstem encephalitis. The majority of NMOSD patients are seropositive for IgG autoantibodies against the water channel protein aquaporin-4 (AQP4-IgG), reflecting underlying aquaporin-4 autoimmunity. Histological findings of the affected CNS tissues of patients from in-vitro and in-vivo studies support that AQP4-IgG is directly pathogenic in NMOSD. It is believed that the binding of AQP4-IgG to CNS aquaporin-4 (abundantly expressed at the endfoot processes of astrocytes) triggers astrocytopathy and neuroinflammation, resulting in acute attacks. These attacks of neuroinflammation can lead to pathologies, including aquaporin-4 loss, astrocytic activation, injury and loss, glutamate excitotoxicity, microglial activation, neuroinflammation, demyelination, and neuronal injury, via both complement-dependent and complement-independent pathophysiological mechanisms. With the increased understanding of these mechanisms underlying this serious autoimmune astrocytopathy, effective treatments for both active attacks and long-term immunosuppression to prevent relapses in NMOSD are increasingly available based on the evidence from retrospective observational data and prospective clinical trials. Knowledge on the indications and potential side effects of these medications are essential for a clear evaluation of the potential benefits and risks to NMOSD patients in a personalized manner. Special issues such as pregnancy and the coexistence of other autoimmune diseases require additional concern and meticulous care. Future directions include the identification of clinically useful biomarkers for the prediction of relapse and monitoring of the therapeutic response, as well as the development of effective medications with minimal side effects, especially opportunistic infections complicated by long-term immunosuppression.

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Efficacy of plasma exchange in acute attacks of neuromyelitis optica spectrum disorders: A systematic review and meta-analysis

Cited by 12 publications

References 36 publications

Therapeutic Response and Possible Biomarkers in Acute Attacks of Neuromyelitis Optica Spectrum Disorders: A Prospective Observational Study

Therapeutic Response and Possible Biomarkers in Acute Attacks of Neuromyelitis Optica Spectrum Disorders: A Prospective Observational Study

Impaired Meningeal Lymphatic Flow in NMOSD Patients With Acute Attack

Treatment of Neuromyelitis Optica Spectrum Disorders

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