A Double-blind Controlled Pilot Study of Plasma Exchange versus Sham Apheresis in Chronic Progressive Multiple Sclerosis

Abstract

ABSTRACT:Twenty patients with chronically progressive multiple sclerosis (MS) were randomised in a double-blind controlled study to assess the efficacy of plasma exchange therapy. All patients were immunosuppressed with prednisone and azathioprine and underwent either plasma exchange or sham apheresis. The 10 patients in each group were similar in age, sex, duration of disease and degree of disability. Clinical and laboratory responses were assessed immediately following the course of exchange or sham therapy, and 3 to 6 months later, by individuals blinded to the type of therapy administered. Although modest improvement was suggested on clinical examination in 7 of 10 patients exchanged and 3 of the 10 sham treated group, this was transient and was not accompanied by any change in disability status scores. No differences in abnormal laboratory investigations were demonstrable between the two patient groups following therapy. We conclude that plasma exchange therapy using this protocol is unlikely to be of clinical benefit as an adjunct in the management of chronically progressive M.S.

Evidence-based guideline update: Plasmapheresis in neurologic disorders [RETIRED]

“…18,[20][21][22] Since the last TTA report, an additional Class II study of azathioprine and plasmapheresis in 11 patients with secondary progressive MS (8 patients completed the trial) concluded that plasmapheresis did not improve outcomes.…”

Meta‐analysis of clinical studies of the efficacy of plasma exchange in the treatment of chronic progressive multiple sclerosis

“…(We were able to calculate the number of patients worsening or improving by 1 or more grades on the DSS from the data reported by Hauser et al [12], but not from the figures presented by Tindall et al [lo] or Gordon et al [24].) Separate analyses were conducted on the reported results of neurologic evaluations at 6, 12,24, and 36 months of follow-up.…”

“…Six identified studies met our selection criteria [3,10,12,13, 22,24]. Their design attributes are summarized in Table I.…”

Clinical Efficacy of Plasma-Exchange in Patients with Progressive forms of Multiple Sclerosis and NMO-Spectrum Disease

“…In two initial small size studies in 1985 patients with chronic MS were treated with PLEX as an add-on therapy to cyclophosphamide, intramuscular immunoglobulins or steroids and azathioprine [3,4]. The first one showed that significantly more patients in the PLEXgroups stabilized or improved at 5 months, as compared with the sham group.…”

“…On the other hand, PLEX was rather ineffective in most of the studies in chronic progressive or secondary progressive MS [3,4]. In purely progressive MS, a study of combination treatment with azathioprine and PLEX in 8 patients with SPMS led to the conclusion that PLEX did not improve clinical outcomes or prevent the formation of Gd-EDPA enhancing lesins in MRI [15].…”