Lymphoplasmapheresis for Steroid-Refractory Neuromyelitis Optica Spectrum Disorder: A Real-World Multicenter Study in...

Area of Science:

• Neuroimmunology
• Hemopurification Techniques
• Autoimmune Disorders

Background:

• Lymphoplasmapheresis (LPE) integrates plasma exchange (PE) with lymphopheresis for hemopurification.
• LPE has shown efficacy in neuroimmune disorders by removing pathological lymphocytes and plasma components.
• This study investigates LPE's mechanisms and clinical utility in acute, steroid-refractory NMOSD.

Purpose of the Study:

• To evaluate the efficacy of LPE in treating acute steroid-refractory NMOSD.
• To elucidate the underlying mechanisms of LPE in NMOSD treatment.
• To provide clinical evidence for LPE as a therapeutic option in NMOSD.

Main Methods:

• A study involving 105 acute-stage steroid-refractory NMOSD patients.
• Monitoring of clinical severity scores, laboratory parameters, immune cell subsets, and cytokine levels.
• Comparison between retrospective (LPE vs. PE) and prospective (LPE) cohorts.

Main Results:

• LPE demonstrated effectiveness and non-inferiority to PE in treating NMOSD.
• Significant reductions in Expanded Disability Status Scale (EDSS) and Activities of Daily Living (ADL) scores were observed with LPE.
• LPE decreased inflammatory markers (AQP4-Ab, CRP, ESR, complements, Ig), proinflammatory cytokines, and modulated immune cell populations (reduced plasmablasts, memory B cells; increased naive CD8+ T cells).

Conclusions:

• LPE shows potential as an acute-phase treatment for AQP4-Ab+ NMOSD.
• The findings support LPE's efficacy, particularly for patients refractory to corticosteroids.
• Further validation studies are recommended to confirm LPE's therapeutic role.