Plasma exchange as a first line therapy in acute attacks of neuromyelitis optica spectrum disorders

Kumawat, Banshi Lal; Choudhary, Richa; Sharma, C. M.; Jain, Deepak; Hiremath, Ashwini

doi:10.4103/aian.aian_365_19

Cited by 25 publications

(3 citation statements)

References 35 publications

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“…We observed adverse events in group 1 only which were mild and were well managed. Our adverse event rate of 3.8% was less when compared with 40% reported by Kumawat et al 16 and 20.8% by Huang et al 4 where the allergic reaction was the most commonest followed by infusion‐related adverse events, hematoma at the phlebotomy site, infections, hypofibrinogenemia, and even death. This could be because Kumawat et al 16 used cell separator based on non‐continuous flow technique for PE, whereas in our study, procedures were done using cell separator based on continuous flow technique.…”

Section: Discussioncontrasting

confidence: 60%

“…Our adverse event rate of 3.8% was less when compared with 40% reported by Kumawat et al 16 and 20.8% by Huang et al 4 where the allergic reaction was the most commonest followed by infusion‐related adverse events, hematoma at the phlebotomy site, infections, hypofibrinogenemia, and even death. This could be because Kumawat et al 16 used cell separator based on non‐continuous flow technique for PE, whereas in our study, procedures were done using cell separator based on continuous flow technique. Also, high allergic reactions reported by Huang et al, 4 were due to use of different replacement fluid (plasma) when compared with our study (5% human serum albumin).…”

Section: Discussioncontrasting

confidence: 60%

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Comparison of efficacy of plasma exchange versus intravenous immunoglobulin as an add‐on therapy in acute attacks of neuromyelitis optica spectrum disorder

Siwach,

Hans,

Takkar

et al. 2024

J of Clinical Apheresis

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IntroductionPlasma exchange (PE) is considered a Category II option for the treatment of acute attacks and relapse cases of neuromyelitis optica spectrum disorder (NMOSD). However, neurologists are also considering intravenous immunoglobulins (IVIg) as an add‐on therapy for this disorder.AimsThe aim of this study is to evaluate the efficacy of PE in acute attacks of NMOSD when compared with IVIg, in terms of improvement in the Expanded disability status scale (EDSS) and activities of daily living (ADL) scale score and levels of anti‐Aquaporin P4 (AQP4) antibody in seropositive patients.MethodsWe enrolled 43 NMOSD patients in two groups: Group 1 (n = 29) received steroids and PE, and Group 2 (n = 14) received steroids with IVIg. The baseline EDSS and ADL scores were recorded and compared with scores at the end of therapy, 4 weeks, and 3 months after. Also, anti‐AQP4 antibody was measured at baseline and post‐therapy in seropositive patients of both groups.ResultsWe observed a significant difference in EDSS (p = 0.00) and ADL score (p = 0.00) at day 10 and 3 months in both groups. However, no significant difference in EDSS, as well as ADL score from baseline (p = 0.83; p = 0.25) to 3 months (p = 0.85; p = 0.19), was observed when delta change of score at 3 months was compared across the two groups (p = 0.39; p = 0.52). We observed improved visual acuity in both groups with mild improvement in findings of magnetic resonance imaging at 3 months. We observed a significant decline in AQP4 antibody concentration (at day 10) in group 1 seropositive patients (p = 0.013) with improved EDSS (p = 0.027) and ADL scores (p = 0.026) of these patients.ConclusionsPE should be considered as a choice of an add‐on therapy in anti‐AQP4 antibody‐positive NMOSD patients compared with IVIg as it is more effective in reducing antibody concentrations.

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Section: Discussioncontrasting

confidence: 60%

Section: Discussioncontrasting

confidence: 60%

Comparison of efficacy of plasma exchange versus intravenous immunoglobulin as an add‐on therapy in acute attacks of neuromyelitis optica spectrum disorder

Siwach,

Hans,

Takkar

et al. 2024

J of Clinical Apheresis

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“…Of the 60 patients evaluated in their study, the probability of complete improvement was greatest for patients receiving PLEX within 0-1 day of symptom onset, with 50% demonstrating complete improvement; the likelihood of improvement decreased to approximately 5% if treatment was initiated after day 20. Another small prospective study evaluated 30 patients receiving PLEX as first line treatment and found significant improvement in disability scores at 3 months [34]. Unfortunately, time to treatment is not the only factor that impacts recovery.…”

Section: High Contrast Visual Acuitymentioning

confidence: 99%

Optic neuritis: current challenges in diagnosis and management

Benard-Seguin¹,

Costello

2022

Current Opinion in Neurology

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Purpose of reviewThe primary aim of this review is to describe the clinical course, salient imaging features, and relevant serological profiles of common optic neuritis (ON) subtypes. Key diagnostic challenges and treatment options will also be discussed. Recent findingsON is a broad term that describes an inflammatory optic nerve injury arising from a variety of potential causes. ON can occur sporadically, however there is particular concern for co-associated central nervous system (CNS) inflammatory syndromes including multiple sclerosis (MS), neuromyelitis optic spectrum disorders (NMOSD), and myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD). The ON subtypes that often herald MS, NMOSD, and MOGAD differ with respect to serological antibody profile and neuroimaging characteristics, yet there is significant overlap in their clinical presentations. A discerning history and thorough examination are critical to rendering the correct diagnosis. SummaryOptic neuritis subtypes vary with respect to their long-term prognosis and accordingly, require different acute treatment strategies. Moreover, delays in identifying MOGAD, and certainly NMOSD, can be highly detrimental because affected individuals are vulnerable to permanent vision loss and neurologic disability from relapses.

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Facilities, selection, outcome measurement, and limitations of therapeutic plasma exchange for neuroimmunological disorders: The South East Asian survey study

Rattanathamsakul

Siritho

Shanthi

et al. 2023

J of Clinical Apheresis

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Introduction Therapeutic plasma exchange (TPE) for neuroimmunological disorders has played an important role in the Southeast Asian region. This study investigates the challenges of performing TPE within the region. Method A questionnaire‐based survey was conducted and launched to 15 South East Asian Therapeutic Plasma Exchange Consortium (SEATPEC) members from seven countries in January 2021. It included demographics, TPE techniques, indications, challenges, timing, outcome measurement, and access to laboratory testing in each local center. Results A total of 15 neurologists from 12 participating centers were included. They usually perform five sessions of TPE (100.0%), with 1 to 1.5 plasma volume (93.3%), and exchanges via the central catheter (100.0%). Acute relapses of neuromyelitis optica spectrum disorder and myasthenia gravis are the most common indications. They used a combination of normal saline and 5% albumin (60.0%) as replacement fluid. Most (66.7%) used TPE as an add‐on treatment in steroid‐refractory cases or as first‐line treatment for severe attacks. They suggested assessing the TPE efficacy of TPE by the interval to the next attack, post‐TPE relapse rates, and TPE‐related complications. The major challenges within our region are expense, reimbursibility, and access to TPE. Conclusion Although countrywise differences exist, all share similarities regarding methods, indications, timing, obstacles, and challenges of TPE for neuroimmunological conditions. Regional collaboration will be essential to identify strategies to reduce these barriers to access to TPE in the future.

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Plasma exchange as a first line therapy in acute attacks of neuromyelitis optica spectrum disorders

Cited by 25 publications

References 35 publications

Comparison of efficacy of plasma exchange versus intravenous immunoglobulin as an add‐on therapy in acute attacks of neuromyelitis optica spectrum disorder

Comparison of efficacy of plasma exchange versus intravenous immunoglobulin as an add‐on therapy in acute attacks of neuromyelitis optica spectrum disorder

Optic neuritis: current challenges in diagnosis and management

Facilities, selection, outcome measurement, and limitations of therapeutic plasma exchange for neuroimmunological disorders: The South East Asian survey study

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