Therapeutic Plasma Exchange in Glucocorticosteroid‐Unresponsive Patients With Clinically Isolated Syndrome

Abstract

Clinically Isolated Syndromes (CIS) summarize clinical features of possible multiple sclerosis (MS) as a first clinical event of the disease. Escalation therapy in CIS episodes comprises high dose glucocorticosteroid (GCS) treatment followed by therapeutic plasma exchange (TPE) in patients unresponsive to GCS. The aim of our study was to analyze TPE effects in CIS patients. Eleven GCS-unresponsive patients exhibiting CIS were treated with TPE. A median of 5.0 (range 3-8) treatments were performed with a median exchange volume of 3.0 L (range 2.2-3.5 L). Standard diagnostic results in CIS patients were collected. In 10 out of 11 patients clinical improvement was observed. In Expanded Disability Status Scale (EDSS) Scoring, a commonly used score to assess disability in MS and CIS patients, significant improvement was shown as well. One patient was a non-responder to TPE. Apheresis treatments were well tolerated in all patients. In the medical control of GCS-unresponsive CIS episodes, TPE appears to be an effective and well-tolerated treatment option. TPE response in CIS patients is comparable to TPE results in GCS-unresponsive MS relapses. Further prospective studies are indicated.

Response to Therapeutic Plasma Exchange as a Rescue Treatment in Clinically Isolated Syndromes and Acute Worsening of Multiple Sclerosis: A Retrospective Analysis of 90 Patients

“…Therefore, clinical experience was derived from inhomogeneous patient populations. Pre-existing studies predominantly included a small number of patients [ 14 , 16 , 17 , 20 – 22 ]. Current prospective clinical trials focusing on TPE in CIS and MS are non-existent.…”

“…All patient information and records were anonymised and de-identified prior to analysis. Of 11 included CIS patients treated between 2001 and 2012, data were previously analysed and published recently [ 14 ].…”

“…If symptoms persist despite GCS treatment, the relapse is defined as GCS-unresponsive and therapeutic plasma exchange (TPE) is recommended [ 7 , 9 , 10 , 13 ]. Meanwhile, TPE is implemented into therapeutic guidelines of a broad spectrum of neurological disorders [ 7 , 14 – 17 ]. The elimination of humoral factors (antibodies, complement factors, cytokines and immune complexes), all assumed to be involved in inflammation and demyelination in CIS and MS, is currently regarded as the rationale for TPE [ 7 , 18 , 19 ].…”

“…The elimination of humoral factors (antibodies, complement factors, cytokines and immune complexes), all assumed to be involved in inflammation and demyelination in CIS and MS, is currently regarded as the rationale for TPE [ 7 , 18 , 19 ]. Beneficial TPE effects have been detected in about 40–90% of patients with acute relapses [ 14 , 16 , 20 – 25 ]. Male sex, preserved reflexes and an early initiation of treatment were associated with successful TPE [ 22 , 23 , 25 , 26 ].…”

“…The response to TPE in the majority of pre-existing inhomogeneous studies was derived from patients with optic neuritis (ON), neuromyelitis optica (NMO), MS and CIS [ 15 – 17 , 22 , 23 , 25 , 26 ]. Studies focusing on MS or CIS included predominantly small patient numbers of 4–60 patients each [ 14 – 16 , 20 – 27 ].…”