Clinical experience of plasmapheresis for neuromyelitis optica patients in Mexico

Gómez‐Figueroa, Enrique; Alvarado-Bolaños, Alonso; García-Estrada, Christian; Zabala-Angeles, Indhira; Sánchez-Rosales, Nayeli Alejandra; Bribiesca-Contreras, Elisa; García-Álvarez, G.; Montes-Pérez, Yessica; Ramos-Vega, Erasmo; Casallas-Vanegas, Adriana; Carrillo-Loza, Karina; Corona, Teresa; Rivas‐Alonso, Verónica; Flores-Rivera, José

doi:10.1016/j.msard.2021.103022

Cited by 6 publications

(5 citation statements)

References 25 publications

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“…12 Another study from Mexico showed that the response rate to PLEX was 39.3%, even when treatment initiation was delayed. 13 Understanding attack activity, severity and response to treatment is important in order to optimize therapeutic decision-making, particularly in lowerincome countries. 2 To the best of our knowledge, no evidence is available on how patients with NMOSD or MOG-AD from the LATAM region are managed and treated during an attack, or how they respond to different therapeutic strategies.…”

Section: Introductionmentioning

confidence: 99%

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Assessing attacks and treatment response rates among adult patients with NMOSD and MOGAD: Data from a nationwide registry in Argentina

Contentti¹,

López²,

Pettinicchi³

et al. 2021

Multiple Sclerosis Journal - Experimental, Translational and Cl

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We aimed to examine treatment interventions implemented in patients experiencing neuromyelitis optica spectrum disorders (NMOSD) attacks (frequency, types, and response). Methods Retrospective study. Data on patient demographic, clinical and radiological findings, and administered treatments were collected. Remission status (complete [CR], partial [PR], no remission [NR]), based on changes in the EDSS score was evaluated before treatment, during attack, and at 6 months. CR was analyzed with a generalized estimating equations (GEEs) model. Results A total of 131 patients (120 NMOSD and 11 myelin oligodendrocyte glycoprotein-antibody-associated diseases [MOGAD]), experiencing 262 NMOSD-related attacks and receiving 270 treatments were included. High-dose steroids (81.4%) was the most frequent treatment followed by plasmapheresis (15.5%). CR from attacks was observed in 47% (105/223) of all treated patients. During the first attack, we observed CR:71.2%, PR:16.3% and NR:12.5% after the first course of treatment. For second, third, fourth, and fifth attacks, CR was observed in 31.1%, 10.7%, 27.3%, and 33.3%, respectively. Remission rates were higher for optic neuritis vs. myelitis (p < 0.001). Predictor of CR in multivariate GEE analysis was age in both NMOSD (OR = 2.27, p = 0.002) and MOGAD (OR = 1.53, p = 0.03). Conclusions This study suggests individualization of treatment according to age and attack manifestation. The outcome of attacks was generally poor.

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Section: Introductionmentioning

confidence: 99%

“…12 Another study from Mexico showed that the response rate to PLEX was 39.3%, even when treatment initiation was delayed. 13…”

Section: Introductionmentioning

confidence: 99%

Assessing attacks and treatment response rates among adult patients with NMOSD and MOGAD: Data from a nationwide registry in Argentina

Contentti¹,

López²,

Pettinicchi³

et al. 2021

Multiple Sclerosis Journal - Experimental, Translational and Cl

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“… 18 Another study on NMOSD patients reported an early response rate of approximately 39%, which was slightly higher than our observations. 19 Ong et al found that the response rate of NMOSD patients improved as they were followed up and reached 87% after 6 months based on their target neurological deficit. 20 Moreover, a systematic review in 2019 on MS reported that the response rate varies from 48% at discharge evaluation to 80% in 14-month follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…In line with our study, G´omez-Figueroa et al did not identify delayed time from relapse onset to TPE and age as predictive factors for response. 19 There are some reports that the severity of clinical symptoms can independently decrease the chance of response to TPE. 10 , 28 , 30 , 31 However, patients who have well responded to TPE once, may be more likely to respond well to subsequent treatments.…”

Section: Discussionmentioning

confidence: 99%

Early clinical response and complications of therapeutic plasma exchange in central nervous system demyelinating diseases

Rashidi,

Naghavi,

Ramezani

et al. 2024

J Cent Nerv Syst Dis

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Background Appropriate treatment reduces the severity and duration of relapses in demyelinating diseases of Central Nervous System (CNS). If high-dose corticosteroids treatment fails, therapeutic plasma exchange (TPE) is considered as a rescue treatment. Objectives This study aimed to investigate early clinical response and complications of TPE and prognostic factors in CNS demyelinating relapses. Design This prospective observational study was designed in a tertiary center during one year. Methods All adult patients diagnosed corticosteroid-resistant Multiple Sclerosis (MS), NeuroMyelitis Optica Spectrum Disorder (NMOSD), idiotypic Transverse Myelitis or Clinical Isolated Syndrome relapses, were eligible. Clinical response is defined based on Expanded Disability Status Scale (EDSS) at discharge. Clinical and laboratory complications recorded. Results Seventy-two patients were analyzed which 58.3% patients were female. MS was diagnosed for 61.1% of cases. Thirty-five patients (48.6%) responded and the mean differences of EDSS significantly decreased 0.60 score (CI95%:0.44-.77). Electrolyte imbalances and thrombocytopenia occurred in 80.6% and 55.6% of cases respectively and 40.3% of patients had systemic reactions. However, 26.4% patients experienced moderate to severe complications. In patients with moderate to severe disability, responders were younger (MD: 8.42 years, CI95%: 1.67-15.17) and had lower EDSS score at admission (median:6, IQR: 5.5-6 against 7.5 IQR: 6.5-8). The risk of failure was higher in active progressive MS patients compared with RRMS patients (OR: 6.06, CI 95%:1.37-26.76). Patients with thrombocytopenia were hospitalized more than others (MD: 1.5 days, CI 95%: 0-3). Females were more prone to hypokalemia and systemic reactions (OR: 3.11, CI 95%:1.17-8.24 and OR: 6.67, CI 95%:2.14-20.81 respectively). Conclusion The most common indication of TPE was corticosteroid-resistant severe MS relapses. About half of the patients presented an early clinical response. Lower disability, younger age and RRMS diagnosis are prognostic factors of better response. One out of four patients experienced moderate to severe complications, mainly electrolyte imbalances and systemic reactions. Appropriate interventions against these complications should be considered during TPE, especially in females.

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“…Apheresis is most beneficial if initiated early in the course of NMOSD, but it can be beneficial even if treatment is delayed. 20 Therapeutic apheresis also has a role in the management of sickle cell anemia, thrombotic thrombocytopenia, acute and chronic inflammatory demyelinating polyneuropathy, myasthenia gravis, anti-glomerular basement membrane disease, organ transplantation, plasma cell dyscrasias, leukemia, and lymphoma.…”

Section: Questions/discussion Points Partmentioning

confidence: 99%

Educational Case: Neuromyelitis optica

2022

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Clinical experience of plasmapheresis for neuromyelitis optica patients in Mexico

Cited by 6 publications

References 25 publications

Assessing attacks and treatment response rates among adult patients with NMOSD and MOGAD: Data from a nationwide registry in Argentina

Assessing attacks and treatment response rates among adult patients with NMOSD and MOGAD: Data from a nationwide registry in Argentina

Early clinical response and complications of therapeutic plasma exchange in central nervous system demyelinating diseases

Educational Case: Neuromyelitis optica

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