Treatment outcomes of first-ever episode of severe optic neuritis

Galetta, Kristin; Ryan, Sophia L.; Manzano, Giovanna S.; Chibnik, Lori B.; Balaban, Denis; Prasad, Sashank; Chwalisz, Bart K; Salazar-Camelo, Andrea; Conway, Steve; Lévy, Michaël; Matiello, Marcelo

doi:10.1016/j.msard.2022.104020

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…Because NMOSD-related optic neuritis appears refractory to PLEX, or response is delayed especially in the elderly, PLEX should begin earlier or combined sequentially with other initial treatment. 26 , 27 …”

Section: Discussionmentioning

confidence: 99%

“…Because NMOSDrelated optic neuritis appears refractory to PLEX, or response is delayed especially in the elderly, PLEX should begin earlier or combined sequentially with other initial treatment. 26,27 PLEX is a technically demanding and invasive extracorporeal blood purification modality with a risk of treatment-related complications. Any plasmapheresis may physiologically stress the heart and kidneys, but physicians are especially concerned when performing PLEX in the elderly because these patients are more highly prone to comorbidities, vulnerable hemodynamic systems, declined protective immunity, and concomitant medications.…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic efficacy and safety of plasmapheresis in elderly patients with neuromyelitis optica spectrum disorder: a single-center observational study

Zhang

Jiao

Cui

et al. 2023

Ther Adv Neurol Disord

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Background: Neuromyelitis optica spectrum disorder (NMOSD) is a devastating autoimmune disorder with cycles of escalating relapse. Rates of diagnosis in the elderly are increasing. Therapeutic decision-making is more challenging in elderly patients due to multiple comorbidities and high risk of drug-induced side effects. Objective: This retrospective study assessed the efficacy and safety of standard plasma exchange (PLEX) treatment in an elderly population with NMOSD. Design: Seventy-six patients with NMOSD who received PLEX were apportioned to two groups as either elderly (⩾60 years, n = 26) or young (<60 years) at the time of the first procedure. Methods: Therapeutic response was judged according to functional recovery at 6 months, as reflected by Expanded Disability Status Scale (EDSS) and visual outcome scale (VOS) scores. Results: The mean age of the 26 elderly patients was 67.7 ± 7.9 years (range 60–87 years); the population was predominantly female (88.5%). PLEX sessions were generally well tolerated among the elderly. Compared with the young patients, the elderly had significantly more comorbidities and concomitant medications. Twenty-four (96.0%) elderly patients showed functional improvement at 6 months after PLEX, of which 15 (60.0%) experienced moderate-to-marked improvement. Six months after the initial PLEX treatment, the patients overall experienced a significant improvement in EDSS and VOS scores. Logistic regression showed that severe optic neuritis attack was a significant independent prognostic factor associated with poor PLEX response. The groups were comparable regarding overall or serious adverse events. The rate of transient hypotension was significantly higher in the elderly compared with the young. Conclusion: PLEX is an effective and safe therapy for elderly patients with NMOSD and should be considered a treatment option during NMOSD attacks. In the elderly, preventive measures against hypotension are recommended before PLEX.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%