Therapeutic plasma exchange in multiple sclerosis patients with an aggressive relapse: an observational analysis in a high-volume center

Abstract

An evidence-based treatment for a Multiple Sclerosis (MS) relapse is an intravenous administration of 3–5 g of Methylprednisolone. In case of insufficient effect or corticosteroids intolerance, the therapeutic plasma exchange (TPE) is indicated. To assess the clinical effect of TPE in treatment of relapse in patients with relapsing-remitting MS (RRMS), we enrolled 155 patients meeting the following criteria (study period: January 2011 to February 2021): (1) age > 18, (2) RRMS according to the McDonald´s 2017 criteria, (3) MS relapse and insufficient effect of corticosteroids/corticosteroids intolerance, (4) baseline EDSS < 8. Exclusion criteria: (1) progressive form of disease, (2) history of previous TPE. Following parameters were monitored: EDSS changes (before and after corticosteroid treatment, before and after TPE; EDSS after TPE was assessed at the next clinical follow-up at the MS Center), and improvement of EDSS according to the number of procedures and baseline severity of relapse. 115 females (74%) and 40 males (26%) were included. The median age was 41 years (IQR 33–47)—131 patients underwent the pulse corticosteroids treatment and TPE, while 24 patients underwent only TPE without any previous corticosteroid treatment. Median baseline EDSS was 4.5 (IQR 3.5–5.5), median EDSS after finishing steroids was 4.5 (IQR 4.0–5.5). EDSS prior to the TPE was 4.5 (IQR 4–6), EDSS after TPE was 4.5 (IQR 3.5–5.5). We observed a significant improvement in the EDSS after TPE (p < 0.001). Sex differences were seen in TPE effectiveness, with median improvement of EDSS in females being −0.5 (IQR 1–0) and in males being 0 (IQR −0.5 to 0), p = 0.048. There was no difference in EDSS improvement by age category: 18–30 years, 31–40 years, 41–50 years, > 50 (p = 0.94), nor by total TPE count (p = 0.91). In this retrospective study of patients with an aggressive relapse and insufficient effect of intravenous corticosteroid treatment, a significant effect of TPE on EDSS improvement was observed. There was no significant difference in TPE effectivity according to the number of procedures, age, nor severity of a relapse. In this cohort, TPE was more effective in females.

Therapeutic Plasma Exchange and Multiple Sclerosis Dysregulations: Focus on the Removal of Pathogenic Circulatory Factors and Altering Nerve Growth Factor and Sphingosine-1-Phosphate Plasma Levels

“…After the application of a cycle of 4 TPE, usually the symptoms of ocular and vestibular motor function, of visual acuity, of walking without assistance, etc., as well as those of acute neurological deficit (Kurtzke's EDSS) were improved significantly. The latest are in line with the EDSS improvements reported by other authors [170]. A significant reduction of the markers of oxidative stress (published previously) was observed as well [58].…”

“…All this points to a therapeutic window corresponding to the pathologically permeable BBB during and immediately after the acute demyelinating attack, which, if not used in proper time, reduces the chances of TRE for partial or complete resolution of the active MRI lesions in the great majority of treated patients [169]. This is usually accompanied by a significant improvement in the EDSS scores in post-TPE patients [170].…”

Peculiarities of the Course, Diagnosis, and Treatment of Multiple Sclerosis

“…Multiple sclerosis mainly affects young and mature people -12 to 55 years old. Although multiple sclerosis can sometimes make its debut in puberty, however, the frequency of the disease gradually increases with age up to the middle of the third decade of life, with a subsequent decrease up to the age of 50-60 [3]. Recently, a trend toward the rejuvenation of multiple sclerosis has been observed.…”

“…Currently, a hypothesis has been made about multiple sclerosis as a multifactorial disease that is, to a great extent, attributable to genetic predisposition (i. e., features of the immune reaction) and the influence of external factors [1].Multiple sclerosis mainly affects young and mature people -12 to 55 years old. Although multiple sclerosis can sometimes make its debut in puberty, however, the frequency of the disease gradually increases with age up to the middle of the third decade of life, with a subsequent decrease up to the age of 50-60 [3]. Recently, a trend toward the rejuvenation of multiple sclerosis has been observed.…”

“…Розсіяним склерозом хворіють переважно люди молодого та зрілого віку -від 12 до 55 років. Хоча інколи розсіяний склероз може дебютувати у пубертатному віці, з віком частота захворюваності поступово збільшується до середини третього десятиріччя життя, з наступним зниженням до 50-60-и річного віку [3]. Останнім часом визначається тенденція до "омолодження" розсіяного склерозу.…”