Plasmapheresis and Intravenous Immune Globulin Improve Neurologic Outcome of Central Pontine Myelinolysis Occurring Post Orthotopic Liver Transplant

Ludwig, Kyle; Thiesset, Heather F.; Gayowski, Timothy; Schwartz, Jason J.

doi:10.1345/aph.1p371

Cited by 19 publications

(9 citation statements)

References 26 publications

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“…In the AMBAR trial, IVIG is used to correct a possible immunological deficit caused by plasma depletion. In fact, this combination approach of PE with albumin plus IVIG replacement has already been used for selected neurologic diseases [60,61]. The AMBAR trial evaluates the maintenance period including combination of monthly LVPE (similar to regular plasma donation plasmaphereses) with IVIG every 4 months.…”

Section: Discussionmentioning

confidence: 99%

Plasma exchange for Alzheimer's disease Management by Albumin Replacement (AMBAR) trial: Study design and progress

Boada

López

Núñez

et al. 2019

A&D Transl Res & Clin Interv

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Introduction Preliminary studies have shown that treatment with plasma exchange (PE) plus therapeutic albumin replacement in patients with Alzheimer's disease (AD) induced mobilization of plasma and cerebrospinal fluid amyloid β protein, associated with an improvement in memory and language functions, as well as the stabilization of brain perfusion, which persisted after treatment discontinuation. Methods A lzheimer's M anagement B y A lbumin R eplacement (AMBAR) is a multicenter, randomized, blinded and placebo-controlled, parallel-group, phase IIb/III trial enrolling patients with mild to moderate AD. The study evaluates PE with different replacement volumes of therapeutic albumin (5% and 20% Albutein®, Grifols), with or without intravenous immunoglobulin (Flebogamma® 5% DIF, Grifols). Patients are randomized to one of three active treatment groups or one control (sham PE) group (1:1:1:1). The intervention regime includes a first 6-week stage of intensive treatment, followed by a second 12-month stage of maintenance treatment. The change from the baseline to the end of treatment periods in the ADAS-Cog and ADCS-ADL scores are the coprimary efficacy variables. Secondary efficacy variables include change from the baseline in scores on cognitive, functional, behavioral, and overall progression tests; changes in plasma and cerebrospinal fluid levels of amyloid β and tau protein; and assessment of structural and functional changes in brain areas of interest. Safety and tolerability are assessed. Results The study has enrolled 496 patients from 41 centers (19 in Spain and 22 in the USA); 347 of these patients were randomized and underwent close to 5000 PEs, of which approximately 25% were sham PEs. Discussion We present an innovative approach for treating AD. The study has been designed to demonstrate clinical efficacy, defined as slow decline of the patient's cognition and brain function. The sample size has adequate power to detect differences between any of the active treatment groups and the control group, as well as between the three active treatment groups combined and the control group.

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Section: Discussionmentioning

confidence: 99%

Plasma exchange for Alzheimer's disease Management by Albumin Replacement (AMBAR) trial: Study design and progress

Boada

López

Núñez

et al. 2019

A&D Transl Res & Clin Interv

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“…[14][15][16][17] Treatment with both PP and IVIG has been trialed as well with significant improvement in four patients. 10,18,19 The use of intravenous methylprednisolone has been described as well, however, further studies are needed to establish the true efficacy of the use of steroids in this setting. 3,20 Case reports usually describe regimens with successful outcomes.…”

Section: Discussionmentioning

confidence: 99%

Favorable Outcomes Following the Use of Triple Therapy in a Patient with Osmotic Demyelination Syndrome

Eze¹,

Agha²,

Duran³

2020

kjm

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“…При этом указания на существенную гипонатриемию отсутствовали. Массивная инфузионная или диуретическая терапия непосредственно перед клиническим ухудшением также не проводилась, а плазмаферез, по мнению некоторых авторов [56], может способствовать улучшению исходов ЦПМ.…”

Section: Discussionunclassified

A case report of central pontine and extrapontine myelinolysis in the combination with spinal cord damage in a patient with tuberculosis in the lung

Savin

Trukhanov

Zyuzya

et al. 2017

Z. nevrol. psikhiatr. im. S.S. Korsakova

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Plasmapheresis and Intravenous Immune Globulin Improve Neurologic Outcome of Central Pontine Myelinolysis Occurring Post Orthotopic Liver Transplant

Abstract: These cases suggest that prompt recognition of CPM and initiation of PP and IVIG may help modulate its progress and improve long-term neurologic outcome.

Cited by 19 publications

References 26 publications

Plasma exchange for Alzheimer's disease Management by Albumin Replacement (AMBAR) trial: Study design and progress

Plasma exchange for Alzheimer's disease Management by Albumin Replacement (AMBAR) trial: Study design and progress

Favorable Outcomes Following the Use of Triple Therapy in a Patient with Osmotic Demyelination Syndrome

A case report of central pontine and extrapontine myelinolysis in the combination with spinal cord damage in a patient with tuberculosis in the lung

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