Short delay to initiate plasma exchange is the strongest predictor of outcome in severe attacks of NMO spectrum disorders

Abstract

These results confirm an improved clinical benefit of early initiation of PLEX during severe attacks of NMO-SD. Perceiving PLEX as a rescue therapy only after steroid failure could be deleterious.

Plasma exchange as a first line therapy in acute attacks of neuromyelitis optica spectrum disorders

“…The only good outcome predictor in the present study was a shorter PLEX delay similar to the previous studies. [1923] The same PLEX response rate was obtained irrespective of Anti-AQP4 antibody status in the present study, which was similar to the Mayo Clinic cohort and in the study by Bonnan et al [2812] As a practical consequence, patient suffering from a severe relapse, the status of Anti-AQP4 antibody should not influence the decision of starting PLEX as promptly as possible.…”

“…[21] Also evident from the results of the present study; the time to PLEX has significantly influenced the outcome, ranging from immediate dramatic improvement (the Lazarus effect) to no effect according to whether they are given early or very late, with shorter delay leading to better outcomes similar to other studies. [142223] However, further prospective, randomized, multicentre clinical trials would be required to definitively answer this question in a better way. For example, PLEX was delayed from onset by a median of 30 days (6-90 days) in Llufriu et al ; in their study, early initiation of PLEX [Odds Ratio (OR) 6.29, 95% Confidence Interval (CI) 1.18-52.96] and improvement at discharge [OR 7.32, 95% CI 1.21-44.38] were significantly associated at 6 months.…”

“…[26] The other two studies by Bonnan et al and Ruprecht et al observed lower residual and mean difference in EDSS score in the add on PLEX-treated group compared to the IVMPS-only group. [2327] In a study by Abboud Hesham et al , 65% of patients treated with IVMPS plus PLEX attained an EDSS score almost same or lower than their baseline at follow-up while only 35% of the IVMPS-only patients achieved their baseline EDSS on follow-up (odds ratio = 3.36, 95% CI 1.0657 to 10.6004, P = 0.0386). [25] In a study by Kumar et al too the patients who were severely disabled, with bad EDSS scores (6-9.5) at baseline and no improvement with IVMPS responded well to PLEX.…”

The establishment of in‐house neurology driven therapeutic plasma exchange infrastructure in a resource‐limited public hospital in Malaysia: Adopting and integrating evidenced‐based health care technology through time

“…We increasingly perform TPE for CNS related immune disorders, that is, a great majority with NMOSD and transverse myelitis. This was supported with recent evidence of its efficacy and outcome which was time‐dependent . We performed lesser number of TPE's for patients with PNS mainly due to two reasons; local treatment protocols and patient‐selection.…”

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

“…Although TPE has been proven to be effective in patients with acute relapses of NMOSD, the role of TPE in RRMS is also gaining ground . Metha Apiwattanakul (MA), Consultant Neurologist from the Prasat Neurological Institute, Thailand summarized the complex, but ground breaking immunopathogenesis of NMOSD and multiple sclerosis (MS) .…”