Immunadsorption bei steroidrefraktärem Schub der Multiplen Sklerose

Mauch, E.; Zwanzger, J.; Hettich, R; Fassbender, Cordula; Klingel, Reinhard; Heigl, Franz

doi:10.1007/s00115-011-3324-5

Cited by 35 publications

(31 citation statements)

References 24 publications

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“…One patient gradually improved but deteriorated again along with the development of jugular venous thrombosis, and two patients did not respond at all. The response to IA seems to be comparable to the best results achieved in PE series [5,6] and to two very recent retrospective analyses of the effect of IA in steroid-refractory MS cases [18,19]. As in our own PE study [10], significant clinical improvement was seen after the third extracorporeal treatment session with a trend in favor of early IA initiation compared to delayed IA initiation.…”

Section: Discussionsupporting

confidence: 86%

Immunoadsorption therapy in patients with multiple sclerosis with steroid-refractory optical neuritis

Koziolek

Tampe

Bahr

et al. 2012

J Neuroinflammation

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BackgroundIn multiple sclerosis relapses refractory to intravenous corticosteroid therapy, plasma exchange is recommended. Immunoadsorption (IA) is regarded as an alternative therapy, but its efficacy and putative mechanism of action still needs to be established.MethodsWe prospectively treated 11 patients with multiple sclerosis who had optical neuritis and fulfilled the indications for apheresis therapy (Trial registration DE/CA25/00007080-00). In total, five IA treatments were performed using tryptophan-IA. Clinical activity (visual acuity, Expanded Disability Status Scale, Incapacity Status Scale), laboratory values and visual evoked potentials were measured before, during and after IA, with a follow-up of six months. Moreover, proteomic analyses were performed to analyze column-bound proteins as well as corresponding changes in patients’ sera.ResultsAfter the third IA, we detected an improvement of vision in eight of eleven patients, whom we termed responders. Amongst these, the mean visual acuity improved from 0.15 ± 0.12 at baseline to 0.47 ± 0.32 after the third IA (P = 0.0252) up to 0.89 ± 0.15 (P < 0.0001) at day 180 ± 10 after IA. Soluble interleukin-2 receptor decreased in responders (P = 0.03), whereas in non-responders it did not. Proteomic analyses of proteins adsorbed to IA columns revealed that several significant immunological proteins as well as central nervous system protein fragments, including myelin basic protein, had been removed by IA.ConclusionsIA was effective in the treatment of corticosteroid-refractory optic neuritis. IA influenced the humoral immune response. Strikingly, however, we found strong evidence that demyelination products and immunological mediators were also cleared from plasma by IA.

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Section: Discussionsupporting

confidence: 86%

Immunoadsorption therapy in patients with multiple sclerosis with steroid-refractory optical neuritis

Koziolek

Tampe

Bahr

et al. 2012

J Neuroinflammation

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“…Two randomized sham-controlled studies have shown a beneficial effect of plasma exchange (PE) in adult patients with acute CNS demyelinating diseases failing to respond to treatment with ACTH or high-dose corticosteroids, respectively [2,3]. Additionally, one uncontrolled prospective study [4] and several case series [5,6] have shown comparable effects of immunoadsorption (IA) in such cases. The International Pediatric Multiple Sclerosis (MS) Study Group states: ‘Children with severe relapses not improving after high-dose IVMP pulse or with contraindications to glucocorticosteroids might benefit from a treatment with plasma exchange' [7].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Apheresis in Pediatric Patients with Acute CNS Inflammatory Demyelinating Disease

Koziolek

Mühlhausen

Friede³

et al. 2013

Blood Purif

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Background/Aims: In adults, plasma exchange (PE) has been shown to be an efficient treatment for severe relapses of acute inflammatory CNS demyelinating diseases. The aim of this study was to evaluate the safety and efficacy of this treatment in pediatric patients. Methods: We retrospectively analyzed a single-center cohort of pediatric patients with inflammatory CNS demyelinating disorders who underwent apheresis between 2007 and 2011. Results: Ten patients (mean age: 11.6 ± 3.4 years) with an acute relapse of multiple sclerosis (n = 5), neuromyelitis optica (n = 2) or acute disseminated encephalomyelitis were included. All receivedmethylprednisolone prior to treatment with either PE (n = 5) or immunoadsorption (n = 5). Apheresis-related side effects were either self-limiting or easily managed. EDSS (Expanded Disability Status Scale) improved in 7 of 8 patients during apheresis and in all patients within 30 days from a median of 7.5 to 1 (p < 0.01). The visual acuity initially worsened during the procedure in 3 of 7 affected eyes (mean 0.09), but improved in all at follow-up (mean: 0.5; p = 0.008). Conclusions: Apheresis was well tolerated and associated with a favorable outcome in all pediatric patients similar to reports in adults.

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“…Die bisher publizierten Erfahrungen zur IA wurden mit der Tryptophan-IA gesammelt und zeigten einheitlich eine ebenso gute Wirksamkeit wie der PA (Abb. 1) [15,16,17,18,19]. Ein wirksames Behandlungsschema für den MS-Schub scheinen 5-6 Behandlungen mit je 2-2,5 l behandeltem Plasmavolumen zu sein.…”

Section: Multiple Skleroseunclassified

“…Patienten mit einer Beteiligung des Nervus opticus und einem beeinträchtigten Sehvermögen zeigten hierbei besonders beeindruckende Ergebnisse (Abb. 2) [16,17,18]. Auch pädiatrische Patienten konnten erfolgreich behandelt werden [20].…”

Section: Multiple Skleroseunclassified

Autoantikörperassoziierte Erkrankungen des zentralen Nervensystems – Neue Indikationen der Immunadsorption

Köhler

2014

Dialyse aktuell

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Unmittelbare Antikörperelimination, Umverteilungspuls (d. h., der rasch induzierte Konzentrationsgradient zwischen intravasalem und extravasalem Verteilungsraum) und Immunmodulation sind die prinzipiellen Wirkmechanismen der therapeutischen Apherese, das heißt von Plasmaaustausch (PA) und Immunadsorption (IA) bei neurologischen Autoimmunerkrankungen. Die therapeutische Apherese wird zur raschen Remission schwerer akuter neurologischer Symptome eingesetzt, aber auch zur langfristigen Rehabilitation klinischer Verläufe, bei denen die medikamentöse Therapie unzureichend anspricht oder durch Nebenwirkungen limitiert wird. PA oder IA sind in diesen Situationen Teil einer multimodalen oder eskalierenden immunologisch ausgerichteten Therapie in Kombination oder alternativ zu intravenös applizierten Immunglobulinen, Steroiden oder dem gesamten Spektrum der Immunsuppressiva und Biologika. Die selektive IA ersetzt zunehmend den unselektiven PA aufgrund der höheren Therapiesicherheit und der zunehmenden Kenntnis über die pathophysiologische Relevanz von Autoantikör-pern. Jüngste Erfolge bei autoimmunen Erkrankungen des ZNS wie Multiple Sklerose (MS), Neuromyelitis optica (NMO) und autoimmune Enzephalitiden haben dieses Konzept bestätigt und Eingang in die aktuellen Leitlinien der Deutschen Gesellschaft für Neurologie (DGN) gefunden.Nervensystems (ZNS) charakterisiert. Die Azetylcholin-Rezeptor-Autoantikörper bei Myasthenia gravis sind das klassische Beispiel. Neu beschriebene Autoantikörper haben das Interesse insbesondere auf das ZNS gelenkt. Die therapeutische Apherese bietet in diesem Kontext eine Option sowohl zur raschen Behandlung akuter schwerer neurologischer Symptome als auch zur langfristigen Stabilisierung der Rehabilitation bei Verläufen, deren medikamentöse Behandlung unzureichend ist oder von nicht akzeptablen Nebenwirkungen begleitet wird. PA oder IA sind in diesen Fällen Teil einer multimodalen oder eskalierenden Therapiestrategie, ergänzend oder alternativ zu intravenösen Immunglobulinen (IVIG), Steroiden, dem gesamten Spektrum der Immunsuppressiva und der Biologika (z. B. Rituximab und Natalizumab). Die IA bzw. die therapeutische Apherese allgemein ist besonders bei hoher Akuität geeignet, zum Beispiel bei drohender Ateminsuffizienz im Rahmen einer myasthenen Krise oder des Guillain-Barré-Syndroms, und hat hierbei weniger Nebenwirkungen als der PA [1]. Die 3 wesentliPathophysiologisch relevante Autoantikörper wurden bei neuromuskulären Erkrankungen und Erkrankungen des peripheren und zentralen Bild: Fotolia, Fotograf/Grafiker: ktdesign Heruntergeladen von: Rutgers University. Urheberrechtlich geschützt.

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Immunadsorption bei steroidrefraktärem Schub der Multiplen Sklerose

Abstract: Immunoadsorption for the treatment of steroid-unresponsive MS relapses was safe and effective. The response rate was comparable to published results with PE. With IA, in contrast to unselective PE, administration of human plasma products is not necessary, avoiding associated risks.

Cited by 35 publications

References 24 publications

Immunoadsorption therapy in patients with multiple sclerosis with steroid-refractory optical neuritis

Immunoadsorption therapy in patients with multiple sclerosis with steroid-refractory optical neuritis

Therapeutic Apheresis in Pediatric Patients with Acute CNS Inflammatory Demyelinating Disease

Autoantikörperassoziierte Erkrankungen des zentralen Nervensystems – Neue Indikationen der Immunadsorption

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