Timing of plasma exchange for neuromyelitis optica spectrum disorders: A meta-analysis

Huang, Xiaoxia; Wu, Jun; Xiao, Yu; Zhang, Yanan

doi:10.1016/j.msard.2020.102709

Cited by 13 publications

(12 citation statements)

References 26 publications

(33 reference statements)

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“…PLEX has been shown to rapidly reduce pathogenic antibodies and simultaneously improve clinical strength in myasthenia gravis, one of the best understood antibody-mediated diseases with a close relationship between antibody levels and symptom burden [ 36 ]. Similar efficacy of PLEX has been demonstrated in other well-known IgG-mediated antibody diseases such as neuromyelitis optica spectrum disorders [ 37 ]. PLEX is considered as the first-line therapy for anti-glomerular basement membrane disease (anti-GBM, also known as Goodpasture disease), a rare small vessel vasculitis that can affect glomerular and pulmonary capillaries leading to rapid organ dysfunction (crescentic glomerulonephritis and diffuse alveolar hemorrhage) [ 38 ].…”

Section: Rationale For Plexsupporting

confidence: 61%

Plasma exchange for severe immune-related adverse events from checkpoint inhibitors: an early window of opportunity?

Katsumoto

Wilson

Giri

et al. 2022

Immunotherapy Advances

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Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of several advanced malignancies leading to durable remission in a subset of patients. Their rapidly expanding use has led to an increased frequency of immune-related adverse events (irAEs). The pathogenesis of irAEs is poorly understood but may involve aberrant activation of T cells leading to inflammatory cytokine release or production of pathogenic antibodies leading to organ damage. Severe irAEs can be extremely debilitating and, in some cases, life threatening. IrAEs may not always be corticosteroid responsive or may require excessively high, often toxic, corticosteroid doses. Therapeutic plasma exchange (PLEX) is a treatment modality that has shown promising results for the management of certain severe irAEs, including irAEs that are not mentioned in current treatment guidelines. PLEX may attenuate ongoing irAEs and prevent delayed irAEs by accelerating clearance of the ICI, or by acutely removing pathogenic antibodies, cytokines, and chemokines. Here, we summarize examples from the literature in which PLEX was successfully used for the treatment of irAEs. We posit that timing may be a critical factor and that earlier utilization of PLEX for life-threatening irAEs may result in more favorable outcomes. In individuals at high risk for irAEs, the availability of PLEX as a potential therapeutic mitigation strategy may encourage life-saving ICI use or rechallenge. Future research will be critical to better define which indications are most amenable to PLEX, particularly to establish the optimal place in the sequence of irAE therapies and to assess the ramifications of ICI removal on cancer outcomes.

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Section: Rationale For Plexsupporting

confidence: 61%

Plasma exchange for severe immune-related adverse events from checkpoint inhibitors: an early window of opportunity?

Katsumoto

Wilson

Giri

et al. 2022

Immunotherapy Advances

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“…Multiple retrospective studies have shown that plasmapheresis, in addition to treatment with intravenous steroids, may improve outcomes if given early 63,64 and is superior to steroids alone 55,64–67 . In a meta-analysis, plasmapheresis significantly reduced the mean expanded disability status scale (EDSS) score by 1.04 points [95% confidence interval (CI): −1.44 to −0.64] 68 …”

Section: Discussionmentioning

confidence: 99%

Optic Neuritis in the Era of NMOSD and MOGAD: A Survey of Practice Patterns in Singapore

Foo

Yau

Singhal

et al. 2022

Asia-Pacific Journal of Ophthalmology

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Purpose: The Optic Neuritis Treatment Trial was a landmark study with implications worldwide. In the advent of antibody testing for neuromyelitis optica spectrum disease (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), emerging concepts, such as routine antibody testing and management, remain controversial, resulting mostly from studies in White populations. We evaluate the practice patterns of optic neuritis investigation and management by neuro-ophthalmologists and neurologists in Singapore. Design: 21-question online survey consisting of 4 clinical vignettes. Methods: The survey was sent to all Singapore Medical Council– registered ophthalmologists and neurologists who regularly manage patients with optic neuritis. Results: Forty-two recipients (17 formally trained neuro-ophthalmol-ogists [100% response rate] and 25 neurologists) responded. Participants opted for routine testing of anti–aquaporin-4 antibodies (88.1% in mild optic neuritis and 97.6% in severe optic neuritis). Anti-MOG antibodies were frequently obtained (76.2% in mild and 88.1% in severe optic neuritis). Plasmapheresis was rapidly initiated (85.7%) in cases of nonresponse to intravenous steroids, even before obtaining anti–aquaporin-4 or anti-MOG serology results. In both NMOSD and MOGAD, oral mycophenolate mofetil was the preferred option if chronic immunosuppression was necessary. Steroids were given for a longer duration and tapered more gradually than in idiopathic optic neuritis cases. Conclusions: Serological testing for NMOSD and MOGAD is considered as a routine procedure in cases of optic neuritis in Singapore, possibly due to local epidemiological features of these conditions. Chronic oral immunosuppression is preferred for the long term, but further research is necessary to establish the efficacy and cost-effectiveness of these practices.

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“…3 6 16 38 39 40 Some predictors were not always found in every study, such as the male sex, retained reflexes, 16 gadolinium-enhancing lesions on magnetic resonance imaging (MRI), and short disease duration, 39 and some predictors were a consistent finding in different studies, such as the early initiation of PLEX, as aforementioned. 3 4 16 27 29 33 36 40 44 45…”

Section: Final Remarksmentioning

confidence: 99%

Plasma exchange in inflammatory demyelinating disorders of the central nervous system: reasonable use in the clinical practice

et al. 2023

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Plasma exchange (PLEX) is a therapeutic apheresis modality in which the plasma is separated from inflammatory factors such as circulating autoreactive immunoglobulins, the complement system, and cytokines, and its therapeutic effect is based on the removal of these mediators of pathological processes. Plasma exchange is well established for various neurological disorders, and it is applied successfully in central nervous system inflammatory demyelinating diseases (CNS-IDD). It mainly modulates the humoral immune system; thus, it has a greater theoretical effect in diseases with prominent humoral mechanisms, such as neuromyelitis optica (NMO). However, it also has a proven therapeutic effect in multiple sclerosis (MS) attacks. Several studies have suggested that patients with severe attacks of CNS-IDD have poor response to steroid therapy but show clinical improvement after the PLEX treatment. Currently, PLEX is generally established only as a rescue therapy for steroid unresponsive relapses. However, there are still research gaps in the literature regarding plasma volume, number of sessions, and how early the apheresis treatment needs to started. Thus, in the present article, we summarize the clinical studies and meta-analyses, especially about MS and NMO, outlining clinical data regarding the experience with therapeutic PLEX in severe attacks of CNS-IDD, the clinical improvement rates, the prognostic factors of a favorable response, and highlighting the likely role of the early apheresis treatment. Further, we have gathered this evidence and suggested a protocol for the treatment of CNS-IDD with PLEX in the routine clinical practice.

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Timing of plasma exchange for neuromyelitis optica spectrum disorders: A meta-analysis

Cited by 13 publications

References 26 publications

Plasma exchange for severe immune-related adverse events from checkpoint inhibitors: an early window of opportunity?

Plasma exchange for severe immune-related adverse events from checkpoint inhibitors: an early window of opportunity?

Optic Neuritis in the Era of NMOSD and MOGAD: A Survey of Practice Patterns in Singapore

Plasma exchange in inflammatory demyelinating disorders of the central nervous system: reasonable use in the clinical practice

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