Immunoadsorption Therapy for Steroid-Unresponsive Relapses in Patients with Multiple Sclerosis

Trebst, Corinna; Bronzlik, Paul; Kielstein, Jan T.; Schmidt, Bernhard M.W.; Stangel, Martin

doi:10.1159/000332397

Cited by 35 publications

(53 citation statements)

References 25 publications

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“…We observed functional improvement in 71.4% of patients shortly after the IA series. Best response was observed in patients with ON with 84% improving in VA. Our results considerably increase evidence on the use of tryptophan IA as therapy for MS relapse and confirm previously published data [13,14,[16][17][18]21] . Studies on PE as escalating regimen for MS relapse predominantly included small patient numbers.…”

Section: Discussionsupporting

confidence: 91%

“…In patients with optic neuritis (ON), the best corrected VA was used to monitor the clinical course. Changes in EDSS and VA were assessed by the following composite parameters for the definition of IA response similar to previous studies [9,12,16,20 ] . Moderate improvement represented a definite change of the neurologic deficit (decrease in EDSS by 0.5 steps in patients with initial EDSS 1-3.5 or improvement in VA ≥ 10 and <20%).…”

Section: Methods and Outcome Measuresmentioning

confidence: 99%

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Escalation Therapy of Steroid Refractory Multiple Sclerosis Relapse with Tryptophan Immunoadsorption - Observational Multicenter Study with 147 Patients

et al. 2016

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Background: A marked proportion of multiple sclerosis (MS) relapses is followed by incomplete recovery. Our aim was to considerably increase the evidence of the clinical use of immunoadsorption (IA) as escalation therapy for patients with MS relapse. Methods: A retrospective multicenter study was performed in MS patients with steroid refractory relapse who were treated with tryptophan IA. The main outcome parameter was change of acute relapse-related disability assessed by Expanded Disability Status Scale (EDSS) and visual acuity (VA) measurements for patients with optic neuritis (ON). IA treatments were performed using single-use tryptophan adsorbers. Results: Data of 147 MS patients and 786 single IA treatments were analyzed. Treatment with IA was commenced in mean 32 ± 35 days after the onset of relapse. One hundred and five out of 147 patients (71.4%) improved functionally after mean 5.4 IA treatments within 7-10 days. EDSS improved from median 5 (interquartile range, IQR 3.5) to 4 (IQR 2.5) (p < 0.001). In patients with ON (n = 32), VA improved after the IA series in 84% of cases from median 0.2 (IQR 0.6) to 0.6 (IQR 0.66) (p < 0.001). In 98.9% of IA treatments, no clinically relevant side effect was reported. Conclusion: Tryptophan IA was found to be effective and well tolerated as escalation therapy for MS relapse.

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Section: Discussionsupporting

confidence: 91%

Section: Methods and Outcome Measuresmentioning

confidence: 99%

Escalation Therapy of Steroid Refractory Multiple Sclerosis Relapse with Tryptophan Immunoadsorption - Observational Multicenter Study with 147 Patients

et al. 2016

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“…Two randomized sham-controlled studies have shown a beneficial effect of plasma exchange (PE) in adult patients with acute CNS demyelinating diseases failing to respond to treatment with ACTH or high-dose corticosteroids, respectively [2,3]. Additionally, one uncontrolled prospective study [4] and several case series [5,6] have shown comparable effects of immunoadsorption (IA) in such cases. The International Pediatric Multiple Sclerosis (MS) Study Group states: ‘Children with severe relapses not improving after high-dose IVMP pulse or with contraindications to glucocorticosteroids might benefit from a treatment with plasma exchange' [7].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Apheresis in Pediatric Patients with Acute CNS Inflammatory Demyelinating Disease

Koziolek

Mühlhausen

Friede³

et al. 2013

Blood Purif

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Background/Aims: In adults, plasma exchange (PE) has been shown to be an efficient treatment for severe relapses of acute inflammatory CNS demyelinating diseases. The aim of this study was to evaluate the safety and efficacy of this treatment in pediatric patients. Methods: We retrospectively analyzed a single-center cohort of pediatric patients with inflammatory CNS demyelinating disorders who underwent apheresis between 2007 and 2011. Results: Ten patients (mean age: 11.6 ± 3.4 years) with an acute relapse of multiple sclerosis (n = 5), neuromyelitis optica (n = 2) or acute disseminated encephalomyelitis were included. All receivedmethylprednisolone prior to treatment with either PE (n = 5) or immunoadsorption (n = 5). Apheresis-related side effects were either self-limiting or easily managed. EDSS (Expanded Disability Status Scale) improved in 7 of 8 patients during apheresis and in all patients within 30 days from a median of 7.5 to 1 (p < 0.01). The visual acuity initially worsened during the procedure in 3 of 7 affected eyes (mean 0.09), but improved in all at follow-up (mean: 0.5; p = 0.008). Conclusions: Apheresis was well tolerated and associated with a favorable outcome in all pediatric patients similar to reports in adults.

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“…In some countries, immunoadsorption (IA), a method to remove immunoglobulins from the circulation by adsorption to either tryptophan or protein A, is used as an alternative to TPE for the treatment of exacerbations of MS and NMOSD [46,47]. Several adult and pediatric cases have been reported in whom NMOSD attacks were successfully treated with IA [33,46,[48][49][50].…”

Section: Treatment Of Nmosd Attacksmentioning

confidence: 99%

“…Several adult and pediatric cases have been reported in whom NMOSD attacks were successfully treated with IA [33,46,[48][49][50].…”

Section: Treatment Of Nmosd Attacksmentioning

confidence: 99%

Present and Future Therapies in Neuromyelitis Optica Spectrum Disorders

Kleiter

Gold

2016

Neurotherapeutics

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Neuromyelitis optica spectrum disorders (NMOSD) are important evolving entities, which have reached much attention in the recent years. NMOSD are characterized by inflammatory lesions in the optic nerves, spinal cord, and central parts of the brain, as well as an autoimmune process directed against aquaporin-4. As disability in NMOSD accumulates by inflammatory damage from attacks, both the treatment and prevention of attacks are decisive for the long-term outcome. NMOSD attacks are treated with highdose intravenous corticosteroids and apheresis therapies, in particular therapeutic plasma exchange. In cases of incomplete remission, escalation of attack treatment is recommended. Preventive therapy is immunosuppressive and should by commenced as early as possible. Apart from classical immunosuppressants such as azathioprine and mycophenolate mofetil, repurposed biologicals are increasingly used. B-cell depletion with rituximab and other agents, inhibition of the interleukin-6 receptor with tocilizumab, and blockade of complement-mediated damage by eculizumab all are promising therapeutic strategies evaluated in randomized controlled trials. In this review, we will discuss present and future immunotherapies for NMOSD and also consider combination of treatments, plasma, cellular and other therapies. Current advances in immunopathological knowledge are translated into innovative concepts and begin a new era of NMOSD therapy.

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Immunoadsorption Therapy for Steroid-Unresponsive Relapses in Patients with Multiple Sclerosis

Cited by 35 publications

References 25 publications

Escalation Therapy of Steroid Refractory Multiple Sclerosis Relapse with Tryptophan Immunoadsorption - Observational Multicenter Study with 147 Patients

Escalation Therapy of Steroid Refractory Multiple Sclerosis Relapse with Tryptophan Immunoadsorption - Observational Multicenter Study with 147 Patients

Therapeutic Apheresis in Pediatric Patients with Acute CNS Inflammatory Demyelinating Disease

Present and Future Therapies in Neuromyelitis Optica Spectrum Disorders

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