Plasma exchange for chronic inflammatory demyelinating polyradiculoneuropathy

Abstract

Evidence from two small trials showed that plasma exchange provides significant short-term benefit in about two-thirds of patients with chronic inflammatory demyelinating polyradiculoneuropathy but rapid deterioration may occur afterwards. Adverse events related to difficulty with venous access, use of citrate and haemodynamic changes are not uncommon. More research is needed to identify agents which will prolong the beneficial action of plasma exchange.

Therapeutic plasma exchange in neurology: 2012

“…The Cochrane Collaboration is organized differently, and so reviews were undertaken on specific diseases rather than on TPE itself. Both CIDP and GBS received the highest ratings [4,5]. For moderate to severe MG, the authors using different terms conclude that TPE is probably effective to use the AAN language [6].…”

“…The consensus statements on TPE in neurological disease by the ASFA [2] and AAN [3] were reviewed, as were Cochrane reviews of TPE in chronic inflammatory demyelinating polyradiculoneuropathy [4], Guillain-Barr e syndrome [5], myasthenia gravis [6], Lambert Eaton Myasthenic Syndrome [7], and paraproteinemic polyneuropathies (IgG/IgA and IgM) [8,9]. Results are summarized and compared.…”

“…Guidelines for diagnosis and treatment exist to assist clinicians and patients [12]. Three first-line treatments have been shown effective in the short-term: TPE, corticosteroids, and IVIg [4,13,14]. Most physicians reserve TPE for severe cases or in cases in which the other therapies do not work, but yet the diagnosis seems correct.…”

Second regional plasmapheresis conference and workshop for Southeast Asia (SEA) on the immunomodulatory role of plasma exchange in central and peripheral nervous system disorders, Kuala Lumpur, Malaysia, 9th December 2017

“…Fu Liong Hiew (FLH) provided an overview of the clinical presentation and the available three evidence-based treatments for CIDP, IVIG, corticosteroids, and TPE. [28][29][30][31] He highlighted the tough decision of many clinicians in deciding first-line treatment due to combination of factors; cost, effectiveness, and side effects of treatments. Although TPE is a proven treatment for CIDP, its use is often reserved to severely disable patients not responding to other conventional first-line treatments.…”

“…Although TPE is a proven treatment for CIDP, its use is often reserved to severely disable patients not responding to other conventional first-line treatments. 29 He also highlighted a subset of CIDP patients with Neurofascin 155 (NF-155) IgG4 antibody, which often refractory to conventional therapies, resulting in progressive functional impairment. 12 The use of TPE in these refractory CIDP patients have shown favorable response.…”