Immunoadsorption in steroid-refractory multiple sclerosis: Clinical experience in 60 patients

Heigl, Franz; Hettich, R; Arendt, R; Durner, Joachim; Koehler, Jana; Mauch, E.

doi:10.1016/j.atherosclerosissup.2012.10.025

Cited by 53 publications

(55 citation statements)

References 27 publications

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“…We observed functional improvement in 71.4% of patients shortly after the IA series. Best response was observed in patients with ON with 84% improving in VA. Our results considerably increase evidence on the use of tryptophan IA as therapy for MS relapse and confirm previously published data [13,14,[16][17][18]21] . Studies on PE as escalating regimen for MS relapse predominantly included small patient numbers.…”

Section: Discussionsupporting

confidence: 81%

Escalation Therapy of Steroid Refractory Multiple Sclerosis Relapse with Tryptophan Immunoadsorption - Observational Multicenter Study with 147 Patients

et al. 2016

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Background: A marked proportion of multiple sclerosis (MS) relapses is followed by incomplete recovery. Our aim was to considerably increase the evidence of the clinical use of immunoadsorption (IA) as escalation therapy for patients with MS relapse. Methods: A retrospective multicenter study was performed in MS patients with steroid refractory relapse who were treated with tryptophan IA. The main outcome parameter was change of acute relapse-related disability assessed by Expanded Disability Status Scale (EDSS) and visual acuity (VA) measurements for patients with optic neuritis (ON). IA treatments were performed using single-use tryptophan adsorbers. Results: Data of 147 MS patients and 786 single IA treatments were analyzed. Treatment with IA was commenced in mean 32 ± 35 days after the onset of relapse. One hundred and five out of 147 patients (71.4%) improved functionally after mean 5.4 IA treatments within 7-10 days. EDSS improved from median 5 (interquartile range, IQR 3.5) to 4 (IQR 2.5) (p < 0.001). In patients with ON (n = 32), VA improved after the IA series in 84% of cases from median 0.2 (IQR 0.6) to 0.6 (IQR 0.66) (p < 0.001). In 98.9% of IA treatments, no clinically relevant side effect was reported. Conclusion: Tryptophan IA was found to be effective and well tolerated as escalation therapy for MS relapse.

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Section: Discussionsupporting

confidence: 81%

Escalation Therapy of Steroid Refractory Multiple Sclerosis Relapse with Tryptophan Immunoadsorption - Observational Multicenter Study with 147 Patients

et al. 2016

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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: 69%

“…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: 64%

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

Hohenstein

Passauer

Ziemssen

et al. 2015

Atherosclerosis Supplements

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“…PE is a nonselective extracorporeal blood purification process with elimination of plasma and subsequent substitution. This also seems to be in accordance with the positive effects of PE in patients with other inflammatory demyelinating syndromes, including NMO who have been unresponsive to high-dose CS therapy 33,34,35. PE should be considered in resistant cases before optic atrophy develops.…”

Section: Plasma Exchangesupporting

confidence: 79%

Optic neuritis as an early sign of multiple sclerosis

Kale¹

2016

106

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Optic neuritis (ON) is an acute inflammatory demyelinating disorder of the optic nerve. The general characteristics of isolated ON include unilateral, subacute, and painful visual loss without systemic or other neurological symptoms. The etiology for ON varies including demyelinating disorders or infections, inflammation, toxic reasons, and genetic disorders. In most cases the responsible etiology may not be known for ON and in this case, it is termed idiopathic ON. When a patient presents with an initial episode of ON, patients should undergo further tests. Assessing the patient with routine blood work, magnetic resonance imaging, cerebrospinal fluid tests, and visual evoked potentials provide further insight. In this review, we aimed to provide a review of ON as an initial symptom of multiple sclerosis and present clinical characteristics, therapy options, and recent literature.

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Immunoadsorption in steroid-refractory multiple sclerosis: Clinical experience in 60 patients

Cited by 53 publications

References 27 publications

Escalation Therapy of Steroid Refractory Multiple Sclerosis Relapse with Tryptophan Immunoadsorption - Observational Multicenter Study with 147 Patients

Escalation Therapy of Steroid Refractory Multiple Sclerosis Relapse with Tryptophan Immunoadsorption - Observational Multicenter Study with 147 Patients

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

Optic neuritis as an early sign of multiple sclerosis

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