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Experience with use of plasmapheresis in chronic progressive multiple sclerosis: the pros
1Department of Neurology, Medical College of Wisconsin, Milwaukee.
Abstract:
Based on the assumptions that multiple sclerosis (MS) is an autoimmune disorder and that plasmapheresis (PP) is an effective means of removing antibodies and other proteins from the circulation, several uncontrolled studies were undertaken to ascertain the role of PP in MS. Since MS is a chronic and persistent rather than monophasic illness, PP has been used in MS in conjunction with a variety of immunosuppressive drug regimens, theoretically to prevent the rebound reformation of the offending protein being removed. Careful analysis of the uncontrolled studies shows wide variance in the types of patients treated; the extent, duration and activity of their disease; and the methodology of PP and the adjunctive immunosuppressive treatment. Nevertheless, the conclusion we reached from this analysis was that prolonged treatment with PP, in conjunction with corticosteroid and other immunosuppressive drug treatment, may have a major clinical effect in patients severely disabled with chronic progressive MS. This in itself is a remarkable conclusion, since it is drawn from data about a form of MS which, by definition, rarely if ever improves spontaneously: more than one-half of the patients reported improvement.
Insights
Plasmapheresis (PP) combined with immunosuppressants may significantly improve severely disabled patients with chronic progressive multiple sclerosis (MS). Over half of patients in uncontrolled studies reported improvement, a notable outcome for this MS form.
Area of Science:
- Neuroimmunology
- Autoimmune Diseases
Background:
- Multiple sclerosis (MS) is presumed to be an autoimmune disorder.
- Plasmapheresis (PP) removes circulating antibodies and proteins.
- MS is a chronic, progressive illness, often unresponsive to spontaneous improvement.
Purpose of the Study:
- To evaluate the role of plasmapheresis (PP) in managing multiple sclerosis (MS).
- To assess the efficacy of PP when used with immunosuppressive therapies in MS patients.
Main Methods:
- Analysis of several uncontrolled studies investigating plasmapheresis in MS.
- Varied patient populations, disease severities, and treatment protocols were considered.
- PP was often administered alongside corticosteroid and other immunosuppressive drugs.
Main Results:
- Significant clinical improvement was observed in patients with severe, chronic progressive MS.
- More than 50% of treated patients reported symptomatic improvement.
- The observed improvements are noteworthy given the typically non-spontaneous recovery in this MS form.
Conclusions:
- Prolonged plasmapheresis, combined with immunosuppressive treatment, shows potential clinical benefits for severely disabled chronic progressive MS patients.
- This therapeutic approach may offer a viable option for a subset of MS patients with limited spontaneous remission potential.