Immunotherapeutics in Pediatric Autoimmune Central Nervous System Disease: Agents and Mechanisms

Therapeutic plasma exchange in paediatric neurology: a critical review and proposed treatment algorithm

“…Since then the range of indications for treatment has expanded significantly, with neurological conditions constituting a large proportion. 5,6 THEORETICAL BASIS FOR PLASMA EXCHANGE A course of TPE typically comprises three to five or more separate exchange procedures undertaken at 24-to 48hourly intervals. 4 In this article we provide an overview of the theoretical basis for TPE in neurological diseases of the central and peripheral nervous systems, review the indications and evidence for TPE in those diseases affecting children, and discuss the practical, technical, safety, and tolerability issues to be considered when embarking upon TPE in children, and its use alongside other immune therapies.…”

“…d See Nosadini et al5 and Dale et al6 for a broader overview of acute immunotherapeutic strategies. a TPE has also been used in severe/fulminant presentations of stiff person syndrome, and in peripheral nervous system manifestations of systemic autoinflammatory diseases (seeKampylafka et al 18 ).…”

Mycophenolate mofetil in paediatric autoimmune or immune‐mediated diseases of the central nervous system: clinical experience and recommendations

“…Other factors that may improve MMF efficacy include adequate dosage and treatment duration, and association with another immune therapy, such as oral steroids, during the introduction phase in view of MMF slow onset of efficacy. The safety profile of MMF seems relatively good, although the possibility of adverse reactions should not be disregarded and weighted in a ‘risk versus benefit’ approach …”

“…The safety profile of MMF seems relatively good, although the possibility of adverse reactions should not be disregarded and weighted in a 'risk versus benefit' approach. 1 Recommendations on MMF use in paediatric autoimmune or immune-mediated CNS disease MMF role in immune therapy, and MMF indications according to mode of action MMF is used as a long-term chronic immune suppressor, usually preceded by first-line immune therapies (corticosteroids, intravenous immunoglobulin and/or plasma exchange), and sometimes second-line immune therapies (rituximab and/or cyclophosphamide). MMF for long-term immune suppression is especially indicated in relapsing conditions, and as a steroid-sparer in steroid-dependent disease.…”

“…Mycophenolate mofetil (MMF) is an immunosuppressive agent that was approved in the mid‐1990s for transplant rejection prophylaxis in the USA and Europe. MMF is a prodrug of mycophenolic acid, an inhibitor of the rate‐limiting enzyme in the de novo synthesis of purine nucleotides, which exerts a specific and potent cytostatic effect on T and B lymphocytes by blocking their proliferative response . MMF is also largely used as a steroid‐sparing agent for chronic immunosuppression in rheumatology and in neurological autoimmune and immune‐mediated conditions, with data suggesting a relatively safe profile .…”