Treatment of the First Acute Relapse Following Therapeutic Plasma Exchange in Formerly Glucocorticosteroid-Unresponsive Multiple Sclerosis Patients—A Multicenter Study to Evaluate Glucocorticosteroid Responsiveness

Abstract

Therapeutic options to treat multiple sclerosis (MS) relapses comprise glucocorticosteroids (GCS) as first-line and therapeutic plasma exchange (TPE) as second-line treatments in GCS-unresponsive patients. No guidelines exist for the treatment of another relapse following TPE. We retrospectively analyzed the responsiveness to GCS in a subsequent relapse following TPE in previously GCS-unresponsive MS patients. Thirty-seven patients with GCS-unresponsive MS relapses received TPE (relapse A). All patients developed another relapse after the completion of TPE and received GCS again (relapse B). The primary study endpoint was the clinical response to GCS and TPE. Marked improvement was defined as clinically significant improvement in function, moderate improvement as a definite change of symptoms without significant impact on function, no effect comprised unchanged symptoms, and deterioration a worsening of symptoms or new deficits. The secondary endpoint was an improvement in expanded disability status scale (EDSS) scoring. All patients were GCS-unresponsive during relapse A and received TPE. During GCS treatment of relapse B, marked improvement was observed in 10, moderate improvement in 24, and no effect in three patients. The EDSS decreased in 15 patients. GCS might remain the first-line relapse treatment following TPE in formerly GCS-unresponsive MS patients.

Comparing Plasma Exchange to Escalated Methyl Prednisolone in Refractory Multiple Sclerosis Relapses

“…However, a large number of patients in our cohort experienced their first demyelinating event and we analyzed only the first relapse per patient, even though intra-individual differences in steroid-responsiveness over time have recently been described [29]. Furthermore, the previously known poor response to steroids used for relapse treatment was not documented anywhere in our medical charts.…”

Methylprednisolone-induced hepatotoxicity in a 16-year-old girl with multiple sclerosis

“…Several treatment options have been proposed in the literature for patients with relapses of MS 43 44. However, even if our patient did not experience further exacerbations, adrenocorticotropic hormone as a first measure and then dexamethasone and plasma exchange seem to be reliable among the most common treatments, according to published data 45–51…”

Sleep Disorders in Multiple Sclerosis

“…Therapeutic options to treat MS relapses include oral glucocorticosteroids [70,71] or their intravenous administration at a high dose as first line and therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG) as second line treatments in glucocorticosteroids unresponsive patients [72], corticotrophin injection and Acthar [73].…”

“…The action mechanisms of glucocorticosteroids in the immune system are pleiotropic, induced apoptosis of peripheral blood leucocytes and down-regulation of T-cell activity delayed for 7-10 days after a 5-day course of administration [72].…”

“…Optimal treatment of relapses increases the chance of limiting or avoiding residual deficits which have been related to the progression of disability in MS [72].…”