Effect of plasma exchange in neuromyelitis optica spectrum disorder: A systematic review and meta‐analysis

Abstract

Objective: To conduct systematic review and meta-analysis for the efficacy of therapeutic plasma exchange (TPE) for neuromyelitis optica spectrum disorder (NMOSD) with an acute attack. Methods: Systematic review was performed using EMBASE and OVID/Medline database. The eligible studies must be the studies of NMOSD patients treated with TPE during the acute phase. They must report treatment outcomes using either Expanded Disability Status Scale (EDSS) or visual acuity (VA) before and after the therapy. Pooled mean difference (MD) was then calculated by combining MDs of each study using the random-effects model. Results: Fifteen studies were identified; eleven with 241 NMOSD patients reported EDSS outcome and four studies with 103 NMOSD reported visual outcomes. The meta-analysis demonstrated a significantly decreased in EDSS after TPE treatment for NMOSD with an acute attack with the pooled MD of 0.83 (95% CI, 0.26-1.40; I 2 69%) comparing pretreatment to immediate posttreatment and 2.13 (95% CI, 1.55-2.70; I 2 31%) comparing pretreatment to posttreatment at 6 months to 1-year follow-up. Unfortunately, only one of the four studies evaluating visual outcomes reported standard deviation in association with mean LogMAR; therefore, the meta-analysis cannot be conducted. Nonetheless, all studies consistently demonstrated the benefit of TPE with improved VA and/or LogMAR after treatment. Interpretation: This systematic review and meta-analysis showed the benefit of TPE during the NMOSD attack with a significantly improved disability status immediately after treatment and during follow-up.

Clinical experience of plasmapheresis for neuromyelitis optica patients in Mexico

“…The decline in EDSS found (0.73) was similar to that reported elsewhere. Studies suggest that mean decline ranges from 0.8 to 1.8 (Kosiyakul et al, 2020;Yu et al, 2021a). Different recording times of post-PLEX EDSS may contribute to observed differences.…”

Impaired Meningeal Lymphatic Flow in NMOSD Patients With Acute Attack

“…Through evaluating the function of mLVs, DCE-MRI will provide objective evidence to predict the relapse of NMOSD. The exact diagnosis is of great significance for the timely treatment and prevention of disease progression, as patients with NMOSD relapses require timely immunomodulatory therapy, including high-dose steroids ( 44 , 45 ), IV immunoglobulin (IVIg) therapy ( 45 , 46 ) and plasma exchange ( 44 , 47 , 48 ) in the acute phase. In this study, the DCE-MRI parameters, especially the TTP values of L-mLVs-SSS, R-mLVs-SSS, and L+R-mLVs-SSS, had the capacity to distinguished ANMOSD patients from CNMOSD patients with high accuracy, high sensitivity and specificity.…”

Early Initiation of Tocilizumab Treatment Against Moderate-to-Severe Myelitis in Neuromyelitis Optica Spectrum Disorder

“…High-dose methylprednisolone (HDMP; 1000 mg/d for five consecutive days) is considered the first-line standard care in acute attacks (7). Intravenous immunoglobulin (IVIG), plasma exchange, or apheresis also show benefits as add-on treatments in patients who are unresponsive to HDMP (8)(9)(10)(11). However, patients can still commonly experience sequelae despite aggressive immunosuppression (12).…”