Immunoadsorption or plasma exchange in steroid-refractory multiple sclerosis and neuromyelitis optica

Abstract

Abstract Background Plasma exchange (PE) and immunoadsorption (IA) are alternative treatments of steroid‐refractory relapses of multiple sclerosis (MS) or neuromyelitis optica (NMO). Methods Adverse events and neurological follow‐ups in 127 MS‐ (62 PE, 65 IA) and 13 NMO‐ (11 PE, 2 IA) patients were retrospectively analyzed. Response was defined by improvements in either expanded disability status scale (EDSS) by at least 1.0 or visual acuity (VA) to 0.5, confirmed after 3 and/or 6 months. Results Hundred and forty patients were included in safety analysis, 102 patients provided sufficient neurological follow‐up‐data. There were no significant differences between IA and PE in side effects (3.9% vs 3.6%, P = .96) or response‐rate ( P = .65). Responders showed significant lower age ( P = .02) and earlier apheresis‐initiation ( P = .01). Subgroup‐analysis confirmed significant lower age in patients with relapsing‐remitting MS (RRMS) /clinical isolated syndrome (CIS). Conclusion IA and PE seem equally safe and effective in steroid‐resistant MS‐ or NMO‐relapses. Early apheresis and low patient age are additional prognostic factors.