Intermittent immunoadsorption in critically ill patients with neuroimmunological disorders: a retrospective study

This study aimed to evaluate the efficacy and safety of intermittent immunoadsorption (IA) in critically ill patients with refractory autoimmune neurological disorders.

We retrospectively reviewed 13 patients admitted to the neurocritical care unit with severe autoimmune encephalitis, Guillain-Barré syndrome, neuromyelitis optica spectrum disorders, or chronic inflammatory demyelinating polyneuropathy, all of whom had failed first-line immunotherapy (intravenous methylprednisolone and/or intravenous immunoglobulin). IA was administered intermittently, with schedules individualized based on clinical status.

The modified Rankin Scale (mRS) improved significantly following IA (p = 0.02), while the Acute Physiology and Chronic Health Evaluation II scores (APACHE II) remained stable (p = 0.95). Serum IgG levels declined by a median of 55.6%. Pathogenic antibody negativity was achieved in 65% of plasma and 38% of cerebrospinal fluid samples. Although 92% experienced treatment interruptions (e.g., infection and hypotension), IA was generally well tolerated and not permanently discontinued.

This study supports the feasibility and clinical utility of intermittent IA in critically ill patients with treatment-refractory neuroimmunological disorders. Despite frequent complications, flexible scheduling allowed continued therapy with sustained benefit. These findings highlight a potentially adaptable treatment strategy in a population often excluded from therapeutic interventions and suggest that IA warrants further study in neurocritical care settings.