Immunoadsorption in steroid-refractory multiple sclerosis

Koziolek, Michael; Kitze, Bernd; Mühlhausen, Johannes; Müller, Gerhard A.

doi:10.1016/j.atherosclerosissup.2012.10.026

Cited by 15 publications

(13 citation statements)

References 21 publications

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“…Despite the remarkable effects on IgG as an indicator of treatment efficacy and more specifically despite the measurable reduction of autoantibodies, we were not able to induce the desired clinical effect in each patient. All patients treated for acute steroid refractory relapsing multiple sclerosis showed a treatment response, which is in line with the existing literature almost exclusively performed with the tryptophan system where response rates of approximately 75% have been reported [6,7]. Our data is in contrast to the report by Moldenhauer et al [8], who could not demonstrate relevant effects using the same adsorber system in a more heterogeneous group of patients with an extended treatment period.…”

Section: Discussionsupporting

confidence: 80%

“…We only had one clinically relevant drop in blood pressure needing immediate intervention. In 143 treatment sessions we have not seen any other severe complication reported by others [6,7] and did not experience IA-associated systemic infections. In contrast, the used system has a very high treatment efficacy leading to an approximately 70% reduction of IgG and a still relevant reduction of IgM and IgA.…”

Section: Discussionmentioning

confidence: 72%

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Immunoadsorption with regenerating systems in neurological disorders – A single center experience

Hohenstein

Passauer

Ziemssen

et al. 2015

Atherosclerosis Supplements

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 72%

Immunoadsorption with regenerating systems in neurological disorders – A single center experience

Hohenstein

Passauer

Ziemssen

et al. 2015

Atherosclerosis Supplements

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“…Visual acuity of 3 eyes even decreased initially; however, an improvement in the months following apheresis was seen in all patients. Such a delayed effect of PE was not seen in a study on adult patients with ON [22], but it has been reported in IA [4,23]. However, ongoing evaluations on adults treated with either PE or IA in our center seem to show that this delayed effect is not dependent on the applied procedure [Mühlhausen et al, manuscript in preparation].…”

Section: Discussionmentioning

confidence: 91%

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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“…However, data from the United States are missing due to lack of approved IA columns by the Food and Drug Administration (FDA). Efficacy of IA and PE in MS seemed to be equal in published data, but up‐to‐date guidelines of the American Society for Apheresis evaluated PE indication in acute relapses of MS as Grade 1B (strong recommendation, high‐quality evidence), IA indication as Grade 2C (weak recommendation, low‐quality or very low‐quality evidence), respectively . These recommendations are based on the past literature.…”

Section: Introductionmentioning

confidence: 99%

Immunoadsorption or plasma exchange in steroid‐refractory multiple sclerosis and neuromyelitis optica

Lipphardt

Mühlhausen

Kitze

et al. 2019

J of Clinical Apheresis

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Background Plasma exchange (PE) and immunoadsorption (IA) are alternative treatments of steroid‐refractory relapses of multiple sclerosis (MS) or neuromyelitis optica (NMO). Methods Adverse events and neurological follow‐ups in 127 MS‐ (62 PE, 65 IA) and 13 NMO‐ (11 PE, 2 IA) patients were retrospectively analyzed. Response was defined by improvements in either expanded disability status scale (EDSS) by at least 1.0 or visual acuity (VA) to 0.5, confirmed after 3 and/or 6 months. Results Hundred and forty patients were included in safety analysis, 102 patients provided sufficient neurological follow‐up‐data. There were no significant differences between IA and PE in side effects (3.9% vs 3.6%, P = .96) or response‐rate (P = .65). Responders showed significant lower age (P = .02) and earlier apheresis‐initiation (P = .01). Subgroup‐analysis confirmed significant lower age in patients with relapsing‐remitting MS (RRMS) /clinical isolated syndrome (CIS). Conclusion IA and PE seem equally safe and effective in steroid‐resistant MS‐ or NMO‐relapses. Early apheresis and low patient age are additional prognostic factors.

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Immunoadsorption in steroid-refractory multiple sclerosis

Cited by 15 publications

References 21 publications

Immunoadsorption with regenerating systems in neurological disorders – A single center experience

Immunoadsorption with regenerating systems in neurological disorders – A single center experience

Therapeutic Apheresis in Pediatric Patients with Acute CNS Inflammatory Demyelinating Disease

Immunoadsorption or plasma exchange in steroid‐refractory multiple sclerosis and neuromyelitis optica

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