Plasma Exchange or Immunoadsorption in Demyelinating Diseases: A Meta-Analysis

Department of Nephrology and Rheumatology, University Medical Center Gottingen, Robert-Koch-Str. 40, D-37075 Goettingen, Germany.

J Clin Med. 2020;9(5)

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PICO Summary

Population

Multiple sclerosis (MS) and neuromyelitis optica (NMO) patients (41 studies, n=1383).

Intervention

Plasma exchange (PE).

Comparison

Immunoadsorption (IA).

Outcome

Therapy response in relapsing-remitting multiple sclerosis and clinically isolated syndrome was 76.6% in PE- and 80.6% in IA-treated patients. Therapy response in NMO was 72.5% in PE-treated patients, and 100% in IA-treated patients.
Abstract
Multiple sclerosis (MS) is an inflammatory disease mainly affecting the central nervous system. In MS, abnormal immune mechanisms induce acute inflammation, demyelination, axonal loss, and the formation of central nervous system plaques. The long-term treatment involves options to modify the disease progression, whereas the treatment for the acute relapse has its focus in the administration of high-dose intravenous methylprednisolone (up to 1000 mg daily) over a period of three to five days as a first step. If symptoms of the acute relapse persist, it is defined as glucocorticosteroid-unresponsive, and immunomodulation by apheresis is recommended. However, several national and international guidelines have no uniform recommendations on using plasma exchange (PE) nor immunoadsorption (IA) in this case. A systematic review and meta-analysis was conducted, including observational studies or randomized controlled trials that investigated the effect of PE or IA on different courses of MS and neuromyelitis optica (NMO). One thousand, three hundred and eighty-three patients were included in the evaluation. Therapy response in relapsing-remitting MS and clinically isolated syndrome was 76.6% (95%CI 63.7-89.8%) in PE- and 80.6% (95%CI 69.3-91.8%) in IA-treated patients. Based on the recent literature, PE and IA may be considered as equal treatment possibilities in patients suffering from acute, glucocorticosteroid-unresponsive MS relapses.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine