Proceedings of the Inaugural Strategy Meeting for the Establishment of a Southeast Asia Regional Therapeutic Plasma Exchange Consortium for Neurological Disorders

Abstract

In conjunction with the third regional Southeast Asian (SEA) therapeutic plasma exchange (TPE) conference in Kuala Lumpur, Malaysia, 25 clinicians and researchers from SEA and South Asian countries attended the inaugural strategy meeting for the establishment of a regional TPE consortium for neurological disorders. The primary objective was to establish regional collaboration to improve delivery of TPE services in SEA. A pre‐meeting survey was conducted to gather insights on disease spectrum, contextual practice challenges, and the need for a regional TPE consensus. Challenges identified include limited healthcare funding in support of diagnostic workup, TPE therapy, as well as development of clinical infrastructure and expertise capacity building. There was favorable interest in developing a working plan contextualized to this region. Strategies to overcome challenges were discussed. This included the need for a comprehensive referral system and network of regional TPE centers suited to local needs, supported by innovative TPE delivery programs.

Impact of Covid‐19 on the therapeutic plasma exchange service within the South East Asian region: Consensus recommendations and global perspectives

“…Types of TPE used included centrifuge (8/9, 89%), membrane filtration (8/ 9, 89%) or both technologies (7/9, 78%) using either dedicated centrifuge or membrane filtration machines or adapting a membrane column to a conventional renal replacement machine) (Table 1). 2,3 Two countries were utilizing alternative methods of TPE (2/9, 22.2%) such as small volume plasma exchange (SVPE) technology in addition to conventional TPE, that is, Myanmar and Bangladesh. In 2019, the total number of TPE cases reported by SEATPEC stake holders was 653 and in Phase 1 of 2020, there was a reduction of 30%, that is, 229 cases versus 325 cases in 2019, which rebounded in the second half of 2020 to January 2021 (286 vs 327 cases in 2019).…”

“…1 In South East Asia (SEA) made up of 11 member countries with a population of over 600 million, the use of therapeutic plasma exchange (TPE) for both central and peripheral neuroimmunological disorders has been evolving and expanding rapidly over the last decade. 2,3 The South East Asian Therapeutic Plasma Exchange Consortium (SEATPEC) was established in 2018 to promote the clinical provision of education and research in TPE for neuroimmunological diseases regionally. 2,3 The Covid-19 pandemic poses unprecendented challenges for the development and expansion of this service.…”

“…2,3 The South East Asian Therapeutic Plasma Exchange Consortium (SEATPEC) was established in 2018 to promote the clinical provision of education and research in TPE for neuroimmunological diseases regionally. 2,3 The Covid-19 pandemic poses unprecendented challenges for the development and expansion of this service.…”

Clinical efficacy of plasma exchange in patients with autoimmune encephalitis

“…These are real-world challenges that neurologists face despite mounting evidence of the benefits of TPE. 9 Whether TPE can rapidly relieve or control severe steroid/intravenous immunoglobulin (IVIG)-refractory antibody-associated AE is not clear. In addition, whether TPE is effective for AE involving intrathecal autoantibody synthesis in cerebrospinal fluid (CSF) antibody-positive but serum antibody-negative patients remains unclear.…”

“…However, the use of TPE in the treatment of AE is still limited for various reasons, including plasma accessibility, cost, and other considerations, such as the lack of sufficient scientific evidence revealing the therapeutic mechanism of TPE. These are real‐world challenges that neurologists face despite mounting evidence of the benefits of TPE 9 . Whether TPE can rapidly relieve or control severe steroid/intravenous immunoglobulin (IVIG)‐refractory antibody‐associated AE is not clear.…”