Immunoadsorption in steroid-refractory multiple sclerosis: clinical experience in 60 patients

Area of Science:

• Neurology
• Immunology
• Biomedical Engineering

Background:

• Multiple sclerosis (MS) is a leading autoimmune inflammatory demyelinating disease of the central nervous system.
• Steroid-resistant relapses in MS often necessitate alternative treatments like plasma exchange (PE).
• Immunoadsorption (IA) offers selective removal of autoantibodies and immune complexes, potentially with fewer adverse effects than PE.

Purpose of the Study:

• To evaluate the efficacy and safety of immunoadsorption (IA) as an escalated therapy for multiple sclerosis (MS) patients with steroid-refractory relapses.
• To compare the outcomes of IA with established treatments like plasma exchange.

Main Methods:

• A retrospective analysis of 60 patients with steroid-refractory MS relapse treated with IA.
• Standardized IA sessions using a tryptophan immunoadsorber, with an average of six sessions per patient.
• Assessment of relapse symptom improvement, neurological examinations (EDSS, FS, visual acuity), and tolerability data.

Main Results:

• An 88% response rate was observed, with 53 out of 60 patients showing clinically relevant improvement.
• Symptomatic improvement was typically noted by the third IA session.
• IA treatment was generally well-tolerated, with a low rate of significant complications (1%) and often achievable via peripheral venous access (87.5%).

Conclusions:

• Immunoadsorption is a safe and effective treatment for steroid-refractory MS relapses.
• The observed response rate of 88% is comparable to plasma exchange outcomes.
• IA's good tolerability and feasibility via peripheral access support its use, potentially in an outpatient setting.