Therapeutic Plasma Exchange as a Treatment for Autoimmune Neurological Disease

Nieto-Aristizábal, Ivana; Vivas, Álvaro J.; Ruiz-Montaño, Pablo; Aragón, Cristian C.; Posso-Osorio, Iván; Quiñones, Jairo; Rivillas, Julián Alejandro; Tobón, Gabriel J.

doi:10.1155/2020/3484659

Cited by 11 publications

(12 citation statements)

References 38 publications

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“…This technique is widespread to reduce the concentration of cytokines and inflammatory mediators. It could be used even in non-infectious inflammation [ 30 ]. FFP used in the PE could decrease the inflammatory cytokines and modulate the hypercoagulation by providing the ADAMTS13 enzyme [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Plasma exchange followed by convalescent plasma transfusion in COVID-19 patients

Roshandel

Sankanian

Salimi

et al. 2021

Transfusion and Apheresis Science

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Background Coronavirus disease 2019 (COVID-19) is an emerged pandemic disease with no specific treatment. One of the potential treatments in newly found infectious disease is plasma exchange (PE) with convalescent plasma transfusion (CPT). This case series aimed to evaluate the primary PE and CPT in five Iranian COVID-19 patients. Methods Five patients with confirmed COVID-19 who had acute respiratory distress syndrome and were supported by mechanical ventilation were treated with two consecutive PE containing fresh frozen plasma (FFP) of healthy donors and 0.9 % saline solution containing 5 % human albumin. Thereafter, CPT was performed just like PE, except that the FFP in this step was substituted with convalescent ABO-matched plasma. Clinical and laboratory factors were evaluated before and after treatments. Results Three to Four patients showed lower body temperature and improved oxygen saturation as well as reduced laboratory factors such as c-reactive protein, lactate dehydrogenase, creatine phosphokinase (total and myocardial isoform), aspartate aminotransferase, blood urea nitrogen, bilirubin (total and direct), D-dimer, interleukin-6, and CD4+/CD8 + T cells ratio initially after PE and continued to improve so that they were discharged. One patient due to secondary hemophagocytic lymphohistiocytosis and extensive lung fungal infection was expired. Discussion Overall, the PE followed by CPT was beneficial in reducing acute inflammation led to a considerable improvement in patients’ clinical features. It seems that PE along with CPT could provide clearance of pro-inflammatory mediators as well as the positive effects of CPT. Controlled studies are required to confirm the effect of PE/CPT compared with other therapeutic approaches.

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Section: Discussionmentioning

confidence: 99%

Plasma exchange followed by convalescent plasma transfusion in COVID-19 patients

Roshandel

Sankanian

Salimi

et al. 2021

Transfusion and Apheresis Science

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“…Plasmapheresis is one of these. It is an extracorporeal circulation therapy to remove pathogenic molecules from the blood of patients with autoimmune disorders [5][6][7][8].…”

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confidence: 99%

Real‐world application of plasmapheresis for neurological disease: Results from the Japan‐Plasmapheresis Outcome and Practice Patterns Study

et al. 2022

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Introduction: Plasmapheresis is a well-recognized treatment for autoimmune neurological diseases in Japan. However, the practice varies depending on the facility, and the actual treatment conditions are unclear.Methods: To clarify real-world conditions, a prospective observational study was conducted on patients with neurological diseases who were scheduled to receive plasmapheresis. A dataset was analyzed that included 887 treatments from 210 patients with myasthenia gravis (MG), multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and other diseases for 82, 30, 24, and 74 patients, respectively. Results: The types of plasmapheresis performed included immunoadsorption plasmapheresis, plasma exchange, and double filtration plasmapheresis with 620, 213, and 54 treatments, respectively. Approximately, 60% of the treatments were performed using peripheral blood access alone. Non-serious adverse events were observed in 10 patients.Conclusions: A statistically significant improvement was observed after plasmapheresis in patients with MG, MS, and NMOSD. These were evaluated using the modified Rankin Scale.

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“…The basic safety analysis of the AMBAR trial previously reported that 90% of the PE procedures were uneventful, 31 as expected based on the safety profile for PE previously reported. 37,[41][42][43] The high percentage of finalized procedures and the relatively low incidence of AEs highlighted the feasibility and safety, respectively, of this procedure in mild-to-moderate AD patients. Here we extended the safety analysis emphasizing the procedure type (TPE vs LVPE), the different PE treatment modalities (albumin doses; with/without IVIG) and TPE venous access (central vs peripheral).…”

Section: Discussionmentioning

confidence: 99%

Feasibility, safety, and tolerability of two modalities of plasma exchange with albumin replacement to treat elderly patients with Alzheimer's disease in the AMBAR study

Boada

Kiprov

Anaya

et al. 2022

J of Clinical Apheresis

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Background In the Alzheimer Management by Albumin Replacement (AMBAR) study, mild‐to‐moderate Alzheimer's disease (AD) patients were treated with a plasma exchange (PE) program. Feasibility and safety of PE in this specific population are poorly understood and were analyzed in detail in this study. Methods Qualified patients were treated with 6 weeks of weekly conventional therapeutic plasma exchange (TPE) with albumin replacement followed by monthly low‐volume plasma exchange (LVPE) for 12 months. The patients were divided into four groups: placebo (sham PE treatment), low‐albumin (20 g), low‐albumin + intravenous immunoglobulin (IVIG) (10 g), and high‐albumin (40 g) + IVIG (20 g). Adverse events (AEs) were recorded and analyzed for all PE treatment groups and PE modalities. Results PE procedure‐related AEs were more common in the active treatment groups (16.9% out of 1283 TPE and 12.5% out of 2203 LVPE were associated with at least one AE, a similar rate than in other PE indications) than in the placebo group (0.7% out of 1223 sham PE). Percentage of procedures with at least one AEs was higher with central venous access compared to peripheral venous access in all three active treatment groups (20.1% vs 13.1%, respectively). Conclusion The TPE and LVPE procedures used in the AMBAR study on mild‐to‐moderate AD population were as safe and feasible as in other therapeutic applications of PE or routine plasmapheresis.

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Therapeutic Plasma Exchange as a Treatment for Autoimmune Neurological Disease

Cited by 11 publications

References 38 publications

Plasma exchange followed by convalescent plasma transfusion in COVID-19 patients

Plasma exchange followed by convalescent plasma transfusion in COVID-19 patients

Real‐world application of plasmapheresis for neurological disease: Results from the Japan‐Plasmapheresis Outcome and Practice Patterns Study

Feasibility, safety, and tolerability of two modalities of plasma exchange with albumin replacement to treat elderly patients with Alzheimer's disease in the AMBAR study

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