Safety and Tolerability of Plasma Exchange and Immunoadsorption in Neuroinflammatory Diseases

Dorst, Johannes; Fillies, Frank; Dreyhaupt, Jens; Şenel, Makbule; Tumani, Hayrettin

doi:10.3390/jcm9092874

Cited by 13 publications

(13 citation statements)

References 27 publications

(58 reference statements)

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“…IA is an alternative apheresis therapy, which selectively depletes immunoglobulins without requiring transfusion of another patient’s plasma [ 28 ]. This extracorporeal technique has been less studied than PE, but shows a similar efficacy in small heterogeneous populations with neuroinflammatory diseases [ 29 , 30 ]. We did not find predictive associations for recovery with age or attack location, in contrast to the recent study of NMOSD attacks in the LATAM registry [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment regimens for neuromyelitis optica spectrum disorder attacks: a retrospective cohort study

Demuth

Guillaume²,

Bourre³

et al. 2022

J Neuroinflammation

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Background Neuromyelitis optica spectrum disorder (NMOSD) attacks require an urgent probabilistic anti-inflammatory therapeutic strategy. As inadequately treated attacks result in disability, there is a need to identify the optimal attack-treatment regimen. Our study aimed to identify predictors of outcome after a first attack in patients with an NMOSD presentation and propose the best treatment strategy. Methods We performed a retrospective cohort study on the French national NMOSD registry (NOMADMUS), a nested cohort of the French multiple sclerosis observatory (OFSEP) recruiting patients with NMOSD presentations in France. We studied the first attack for any independent locations of clinical core characteristic of NMOSD, in treatment-naïve patients. The primary outcome was the evolution of the Expanded Disability Status Scale (EDSS) score at 6 months, stratified in two ways to account for recovery (return to baseline EDSS score) and treatment response (classified as “good” if the EDSS score decreased by ≥ 1 point after a nadir EDSS score ≤ 3, or by ≥ 2 points after a nadir EDSS score > 3). We used ordinal logistic regression to infer statistical associations with the outcome. Results We included 211 attacks among 183 patients (104 with anti-AQP4 antibodies, 60 with anti-MOG antibodies, and 19 double seronegative). Attack treatment regimens comprised corticosteroids (n = 196), plasma exchanges (PE; n = 72) and intravenous immunoglobulins (n = 6). Complete recovery was reached in 40 attacks (19%) at 6 months. The treatment response was “good” in 134 attacks (63.5%). There was no improvement in EDSS score in 50 attacks (23.7%). MOG-antibody seropositivity and short delays to PE were significantly and independently associated with better recovery and treatment response. Conclusions We identified two prognostic factors: serostatus (with better outcomes among MOG-Ab-positive patients) and the delay to PE. We, therefore, argue for a more aggressive anti-inflammatory management of the first attacks suggesting an NMOSD presentation, with the early combination of PE with corticosteroids.

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Section: Discussionmentioning

confidence: 99%

Treatment regimens for neuromyelitis optica spectrum disorder attacks: a retrospective cohort study

Demuth

Guillaume²,

Bourre³

et al. 2022

J Neuroinflammation

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“…In a single center prospective study, significant improvement of the modified Rankin scale was seen in patients with severe refractory AE after treatment with PLEX, steroids and IVIG compared to those that only received steroids and IVIG ( 164 ). Studies have shown that both plasmapheresis and Ig-apheresis are well tolerated with minimal adverse effects supporting their use in clinical practice ( 165 ). Taken together, plasmapheresis appears to be a safe and efficient escalation therapy for acute IgG4-AID.…”

Section: Treatments Of Igg4 Neurological Diseasesmentioning

confidence: 99%

IgG4 Autoantibodies in Organ-Specific Autoimmunopathies: Reviewing Class Switching, Antibody-Producing Cells, and Specific Immunotherapies

et al. 2022

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Organ-specific autoimmunity is often characterized by autoantibodies targeting proteins expressed in the affected tissue. A subgroup of autoimmunopathies has recently emerged that is characterized by predominant autoantibodies of the IgG4 subclass (IgG4-autoimmune diseases; IgG4-AID). This group includes pemphigus vulgaris, thrombotic thrombocytopenic purpura, subtypes of autoimmune encephalitis, inflammatory neuropathies, myasthenia gravis and membranous nephropathy. Although the associated autoantibodies target specific antigens in different organs and thus cause diverse syndromes and diseases, they share surprising similarities in genetic predisposition, disease mechanisms, clinical course and response to therapies. IgG4-AID appear to be distinct from another group of rare immune diseases associated with IgG4, which are the IgG4-related diseases (IgG4-RLD), such as IgG4-related which have distinct clinical and serological properties and are not characterized by antigen-specific IgG4. Importantly, IgG4-AID differ significantly from diseases associated with IgG1 autoantibodies targeting the same organ. This may be due to the unique functional characteristics of IgG4 autoantibodies (e.g. anti-inflammatory and functionally monovalent) that affect how the antibodies cause disease, and the differential response to immunotherapies of the IgG4 producing B cells/plasmablasts. These clinical and pathophysiological clues give important insight in the immunopathogenesis of IgG4-AID. Understanding IgG4 immunobiology is a key step towards the development of novel, IgG4 specific treatments. In this review we therefore summarize current knowledge on IgG4 regulation, the relevance of class switching in the context of health and disease, describe the cellular mechanisms involved in IgG4 production and provide an overview of treatment responses in IgG4-AID.

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“…The tolerance level of PE and IA were almost similar. Contrary to the previous studies, a higher adverse event (AE) for IA has been reported [195]. The therapeutic effect of IA is mainly associated with an intravascular decrease in autoantibodies, immunomodulatory activity, and redistribution of antibodies.…”

Section: Therapeutic Plasma Exchange (Tpe) Therapy In Mg Treatmentmentioning

confidence: 73%

Myasthenia Gravis: Novel Findings and Perspectives on Traditional to Regenerative Therapeutic Interventions

Huang¹,

Wu²,

Wang³

et al. 2022

Aging and disease

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The prevalence of myasthenia gravis (MG), an autoimmune disorder, is increasing among all subsets of the population leading to an elevated economic and social burden. The pathogenesis of MG is characterized by the synthesis of autoantibodies against the acetylcholine receptor (AChR), low-density lipoprotein receptor-related protein 4 (LRP4), or muscle-specific kinase at the neuromuscular junction, thereby leading to muscular weakness and fatigue. Based on clinical and laboratory examinations, the research is focused on distinguishing MG from other autoimmune, genetic diseases of neuromuscular transmission. Technological advancements in machine learning, a subset of artificial intelligence (AI) have been assistive in accurate diagnosis and management. Besides, addressing the clinical needs of MG patients is critical to improving quality of life (QoL) and satisfaction. Lifestyle changes including physical exercise and traditional Chinese medicine/herbs have also been shown to exert an ameliorative impact on MG progression. To achieve enhanced therapeutic efficacy, cholinesterase inhibitors, immunosuppressive drugs, and steroids in addition to plasma exchange therapy are widely recommended. Under surgical intervention, thymectomy is the only feasible alternative to removing thymoma to overcome thymoma-associated MG. Although these conventional and current therapeutic approaches are effective, the associated adverse events and surgical complexity limit their wide application. Moreover, Restivo et al. also, to increase survival and QoL, further recent developments revealed that antibody, gene, and regenerative therapies (such as stem cells and exosomes) are currently being investigated as a safer and more efficacious alternative. Considering these above-mentioned points, we have comprehensively reviewed the recent advances in pathological etiologies of MG including COVID-19, and its therapeutic management.

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Safety and Tolerability of Plasma Exchange and Immunoadsorption in Neuroinflammatory Diseases

Cited by 13 publications

References 27 publications

Treatment regimens for neuromyelitis optica spectrum disorder attacks: a retrospective cohort study

Treatment regimens for neuromyelitis optica spectrum disorder attacks: a retrospective cohort study

IgG4 Autoantibodies in Organ-Specific Autoimmunopathies: Reviewing Class Switching, Antibody-Producing Cells, and Specific Immunotherapies

Myasthenia Gravis: Novel Findings and Perspectives on Traditional to Regenerative Therapeutic Interventions

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