Factors associated with the effectiveness of plasma exchange for the treatment of NMO-IgG-positive neuromyelitis optica spectrum disorders

Abstract

To identify factors associated with plasma exchange response in neuromyelitis optica (NMO) spectrum disorders, the clinical and magnetic resonance imaging (MRI) features of 31 NMO-IgG-positive patients receiving plasma exchange for steroid-resistant exacerbations were analyzed. Functional improvement was observed in 65% of the patients. A lower baseline Expanded Disability Status Scale score was associated with favorable response (p = 0.040). Patients without cord atrophy had a higher success rate than patients with atrophy (p = 0.016). Levels of NMO-IgG did not differ between responders and non-responders before and after plasma exchange. In conclusion, a minimal pre-existing disability is the primary determinant of the effectiveness of plasma exchange.

Neuromyelitis optica: Evaluation of 871 attacks and 1,153 treatment courses

“…10,[16][17][18][19][20][21] Factors associated with favorable outcome of PE are attacks other than optic neuritis (ON), fewer prior attacks, shorter disease duration, and lower pre-existing disability. [18][19][20]22,23 A beneficial use of IA for NMO attacks has been reported only in individual adult and pediatric cases. 15,[24][25][26] We conducted a retrospective analysis of 871 NMO/NMOSD attacks in 185 patients documented in the Neuromyelitis Optica Study Group (NEMOS) registry to identify the frequency, sequence, and efficacy of applied attack therapies.…”

Plasma Exchange in a Patient with Tumefactive, Corticosteroid-Resistant Multiple Sclerosis

“…26 In patients with NMO, factors found to be associated with better recovery include non-optic neuritis attack, preserved reflexes, lower baseline EDSS scores, and fewer previous relapses. 27 The present patient had many favorable features predicting a beneficial response to PLEX, including a relatively short disease course of approximately 10 months, relapsing-remitting disease, and brisk reflexes. Her EDSS score improved to her previous baseline score after PLEX, and she had disease stabilization.…”

Present and Future Therapies in Neuromyelitis Optica Spectrum Disorders

“…TPE effectively eliminates pathogenic AQP4-IgG from the patient's circulation [44], which is one reason to use TPE in NMOSD. However, TPE improves attack-related disability not only in seropositive but also in seronegative patients [40,42,45], where putatively other types of autoantibodies may exist. Attacks other than ON, fewer prior attacks, shorter disease duration, and lower preexisting disability are factors associated with the favorable outcome of TPE [40,[43][44][45].…”

“…However, TPE improves attack-related disability not only in seropositive but also in seronegative patients [40,42,45], where putatively other types of autoantibodies may exist. Attacks other than ON, fewer prior attacks, shorter disease duration, and lower preexisting disability are factors associated with the favorable outcome of TPE [40,[43][44][45]. If TPE is not applicable, for example, owing to contraindications, a second course of IVMP at a higher dose of up to 2 g for 5 days can be given [8].…”