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Immunoadsorption versus double-dose methylprednisolone in refractory multiple sclerosis relapses.

Steffen Pfeuffer1, Leoni Rolfes1,2, Timo Wirth1

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Immunoadsorption significantly improved outcomes for multiple sclerosis relapses compared to methylprednisolone. This treatment effectively reduced B cell subsets, correlating with better clinical improvement in patients with steroid-refractory relapses.

Keywords:
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Area of Science:

  • Neuroscience
  • Immunology

Background:

  • Intravenous methylprednisolone is standard for multiple sclerosis (MS) relapses but is ineffective for up to 25% of patients.
  • Immunoadsorption (IA) is used for refractory MS relapses, but lacks prospective comparative studies.

Purpose of the Study:

  • To compare the efficacy of tryptophan-immunoadsorption versus high-dose methylprednisolone in patients with steroid-refractory acute multiple sclerosis relapses.

Main Methods:

  • An observational study analyzed 42 patients with steroid-refractory MS relapses treated with either IA (16 patients) or double-dose methylprednisolone (26 patients).
  • Outcomes were assessed at discharge and 3 months post-treatment.
  • Immune profiling via flow cytometry and proteomic analysis were performed.

Main Results:

  • Immunoadsorption showed significantly higher treatment response rates at discharge (OR 10.7, p=0.005) and best response at follow-up (OR 103.2, p=0.001) compared to methylprednisolone.
  • IA profoundly reduced B cell subsets, correlating with clinical improvement, unlike methylprednisolone.
  • IA modulated cytokine networks, reduced B cell-related cytokines, immunoglobulins, and coagulation factors.

Conclusions:

  • Immunoadsorption demonstrated superior outcomes compared to high-dose methylprednisolone for steroid-refractory MS relapses.
  • The modulation of B cell function appears to be a key mechanism underlying IA's clinical efficacy.