Plasma Exchange or Immunoadsorption in Demyelinating Diseases: A Meta-Analysis

Area of Science:

• Neurology
• Immunology
• Clinical Therapeutics

Background:

• Multiple sclerosis (MS) is a central nervous system inflammatory disease causing demyelination and axonal loss.
• Acute MS relapses are initially treated with high-dose intravenous methylprednisolone.
• Glucocorticosteroid-unresponsive relapses necessitate alternative immunomodulatory treatments like apheresis.

Purpose of the Study:

• To systematically review and meta-analyze the efficacy of plasma exchange (PE) and immunoadsorption (IA) for acute, glucocorticosteroid-unresponsive MS relapses.
• To compare treatment responses between PE and IA in patients with MS and neuromyelitis optica (NMO).

Main Methods:

• Systematic review and meta-analysis of observational studies and randomized controlled trials.
• Inclusion of studies investigating PE or IA in various MS courses and NMO.
• Evaluation of data from 1,383 patients.

Main Results:

• Therapy response rates were 76.6% for PE and 80.6% for IA in patients with relapsing-remitting MS and clinically isolated syndrome.
• No significant difference in treatment effectiveness was observed between PE and IA.
• Both PE and IA demonstrated therapeutic benefits in acute, steroid-refractory MS relapses.

Conclusions:

• Plasma exchange and immunoadsorption are comparable and effective treatment options for acute, glucocorticosteroid-unresponsive MS relapses.
• These apheresis methods provide valuable therapeutic alternatives when standard steroid treatment is insufficient.
• Further research may clarify optimal use in specific MS subtypes and NMO.