Therapeutic Plasma Exchange in Steroid-refractory Multiple Sclerosis Relapses. A Retrospective Two-center Study

Overview

Journal Ther Adv Neurol Disord

Specialty Neurology

Date 2021 Feb 8

PMID 33552236

Citations 9

Authors

Stephan Blechinger

Johannes Ehler

Gabriel Bsteh

Alexander Winkelmann

Fritz Leutmezer

Stefanie Meister

Agnes Santer

Michael Hecker

Thomas Berger

Paulus Rommer

Uwe Klaus Zettl

Affiliations

Soon will be listed here.

Abstract

Background: Therapeutic plasma exchange (TPE) is frequently used in glucocorticosteroid (GCS)-refractory multiple sclerosis (MS) relapses. Data regarding predictors of treatment response are scarce. The objective of this study was to analyze predictive factors for response to TPE in GCS-refractory MS patients.

Methods: A total of 118 MS patients in two tertiary MS centers were analyzed. Primary outcome was TPE response defined as marked, mild, or no improvement. Secondary outcome was change in expanded disability status scale (ΔEDSS). ΔEDSS and relapse activity within 6 months after TPE were studied.

Results: Marked or mild improvement was observed in 78.8% of patients. ΔEDSS correlated significantly inversely with time from relapse to start of TPE (τ = -0.239, = 0.001), age (τ = 0.182, = 0.009) and disease duration (τ = -0.167, = 0.017). In multivariate analysis, TPE response was predicted by diagnosis of relapsing MS [odds ratio (OR): 3.1], gadolinum-enhancement on magnetic resonance imaging (OR 3.2), age (OR 0.5 per 5 years older) and time from relapse onset to TPE (OR 0.7 per 7 days longer).

Conclusion: Patients with longer disease duration and higher EDSS pre and post-TPE were more likely to show further disability progression or relapses within 6 months after TPE. No sustained effects were observed during the follow-up period.

Citing Articles

Apheresis for the treatment of relapses in MS and NMOSD: reduced antibody reactivities, gene expression changes and potential clinical response indicators.

Hecker M, Fitzner B, Ludwig-Portugall I, Bohne F, Heyland E, Klehmet J Front Immunol. 2025; 16:1531447.

PMID: 39949773 PMC: 11821495. DOI: 10.3389/fimmu.2025.1531447.

Efficacy and Safety of Rescue Treatment with Plasma Exchange in Patients with Acute Inflammatory Neurological Disorders: A Single Center Experience.

Iacono S, Schiro G, Salemi G, Scire E, Aridon P, Melfa M Neurol Int. 2024; 16(4):761-775.

PMID: 39051217 PMC: 11270162. DOI: 10.3390/neurolint16040056.

Early clinical response and complications of therapeutic plasma exchange in central nervous system demyelinating diseases.

Rashidi M, Naghavi S, Ramezani N, Ashtari F, Shaygannejad V, Hosseini S J Cent Nerv Syst Dis. 2024; 16:11795735241262738.

PMID: 38903856 PMC: 11188695. DOI: 10.1177/11795735241262738.

Serum neurofilament light chain and glial fibrillary acidic protein for predicting response to apheresis in steroid-refractory multiple sclerosis relapses.

Vardakas I, Dorst J, Huss A, Mayer B, Fangerau T, Taranu D Eur J Neurol. 2024; 31(8):e16323.

PMID: 38700322 PMC: 11235822. DOI: 10.1111/ene.16323.

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.

Tonev D, Momchilova A Curr Issues Mol Biol. 2023; 45(10):7749-7774.

PMID: 37886933 PMC: 10605592. DOI: 10.3390/cimb45100489.

References

Fraussen J, Claes N, de Bock L, Somers V . Targets of the humoral autoimmune response in multiple sclerosis. Autoimmun Rev. 2014; 13(11):1126-37. DOI: 10.1016/j.autrev.2014.07.002. View

Wiendl H, Toyka K, Rieckmann P, Gold R, Hartung H, Hohlfeld R . Basic and escalating immunomodulatory treatments in multiple sclerosis: current therapeutic recommendations. J Neurol. 2008; 255(10):1449-63. DOI: 10.1007/s00415-008-0061-1. View

Ellenberger D, Eichstadt K, Flachenecker P, Friede T, Haas J, Kleinschnitz C . Decreasing longitudinal use of glucocorticosteroids in multiple sclerosis. Mult Scler Relat Disord. 2018; 25:173-174. DOI: 10.1016/j.msard.2018.07.040. View

Weinshenker B, OBrien P, Petterson T, Noseworthy J, Lucchinetti C, Dodick D . A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease. Ann Neurol. 1999; 46(6):878-86. DOI: 10.1002/1531-8249(199912)46:6<878::aid-ana10>3.0.co;2-q. View

Keegan M, Pineda A, McClelland R, Darby C, Rodriguez M, Weinshenker B . Plasma exchange for severe attacks of CNS demyelination: predictors of response. Neurology. 2002; 58(1):143-6. DOI: 10.1212/wnl.58.1.143. View

Llufriu S, Castillo J, Blanco Y, Ramio-Torrenta L, Rio J, Valles M . Plasma exchange for acute attacks of CNS demyelination: Predictors of improvement at 6 months. Neurology. 2009; 73(12):949-53. DOI: 10.1212/WNL.0b013e3181b879be. View

Keegan M, Konig F, McClelland R, Bruck W, Morales Y, Bitsch A . Relation between humoral pathological changes in multiple sclerosis and response to therapeutic plasma exchange. Lancet. 2005; 366(9485):579-82. DOI: 10.1016/S0140-6736(05)67102-4. View

Rommer P, Buckow K, Ellenberger D, Friede T, Pitschnau-Michel D, Fuge J . Patients characteristics influencing the longitudinal utilization of steroids in multiple sclerosis--an observational study. Eur J Clin Invest. 2015; 45(6):587-93. DOI: 10.1111/eci.12450. View

Rieckmann P, Toyka K, Bassetti C, Beer K, Beer S, Buettner U . Escalating immunotherapy of multiple sclerosis--new aspects and practical application. J Neurol. 2004; 251(11):1329-39. DOI: 10.1007/s00415-004-0537-6. View

10.

Tsokos G, Balow J . Immunosuppressive agents and plasmapheresis in immunological disorders. J Immunopharmacol. 1985; 7(1):1-15. DOI: 10.3109/08923978509026465. View

11.

Stork L, Ellenberger D, Beissbarth T, Friede T, Lucchinetti C, Bruck W . Differences in the Reponses to Apheresis Therapy of Patients With 3 Histopathologically Classified Immunopathological Patterns of Multiple Sclerosis. JAMA Neurol. 2018; 75(4):428-435. PMC: 5885209. DOI: 10.1001/jamaneurol.2017.4842. View

12.

Repovic P . Management of Multiple Sclerosis Relapses. Continuum (Minneap Minn). 2019; 25(3):655-669. DOI: 10.1212/CON.0000000000000739. View

13.

Rommer P, Milo R, Han M, Satyanarayan S, Sellner J, Hauer L . Immunological Aspects of Approved MS Therapeutics. Front Immunol. 2019; 10:1564. PMC: 6637731. DOI: 10.3389/fimmu.2019.01564. View

14.

Lublin F, Reingold S . Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology. 1996; 46(4):907-11. DOI: 10.1212/wnl.46.4.907. View

15.

Thompson A, Banwell B, Barkhof F, Carroll W, Coetzee T, Comi G . Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2017; 17(2):162-173. DOI: 10.1016/S1474-4422(17)30470-2. View

16.

Kurtzke J . Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983; 33(11):1444-52. DOI: 10.1212/wnl.33.11.1444. View

17.

Zettl U, Hartung H, Pahnke A, Brueck W, Benecke R, Pahnke J . Lesion pathology predicts response to plasma exchange in secondary progressive MS. Neurology. 2006; 67(8):1515-6. DOI: 10.1212/01.wnl.0000240067.03948.68. View

18.

Lassmann H . Pathogenic Mechanisms Associated With Different Clinical Courses of Multiple Sclerosis. Front Immunol. 2019; 9:3116. PMC: 6335289. DOI: 10.3389/fimmu.2018.03116. View

19.

Lucchinetti C, Bruck W, Parisi J, Scheithauer B, Rodriguez M, Lassmann H . Heterogeneity of multiple sclerosis lesions: implications for the pathogenesis of demyelination. Ann Neurol. 2000; 47(6):707-17. DOI: 10.1002/1531-8249(200006)47:6<707::aid-ana3>3.0.co;2-q. View

20.

Reich D, Lucchinetti C, Calabresi P . Multiple Sclerosis. N Engl J Med. 2018; 378(2):169-180. PMC: 6942519. DOI: 10.1056/NEJMra1401483. View