Highlights
- •Benefit of plasma exchange vs pulse steroid treatment was reviewed in Asian NMOSD.
- •Either IVMP or IVMP+PLEX showed neurological improvement in acute attacks of NMOSD.
- •Add-on PLEX should be considered in NMOSD who were not responsive to IVMP alone.
Abstract
Background
Plasma exchange (PLEX) is routinely performed in neuromyelitis optica spectrum disorders
(NMOSD) patients with an acute attack who do not respond to corticosteroids treatment.
Objective
To compare treatment outcomes in NMOSD patients with an acute attack between the two
groups.
Methods
We retrospectively studied 67 attacks from 52 NMOSD patients. Outcome measurements
using Expanded Disability Status Scale (EDSS), modified Rankin Scale (mRS) were compared.
Results
There were 23 IVMP responders, 16 IVMP non-responders refusing PLEX, 12 IVMP non-responders/PLEX
responders, and 16 IVMP/PLEX non-responders. The IVMP-responders showed faster improvement
since the time of discharge but seemed to have less treatment benefit over time. However,
IVMP non-responders/PLEX responders showed continuous and maximum improvement at 6
months (ΔEDSS from nadir: 1 for IVMP-responders vs 0.5 for IVMP non-responders without
PLEX vs 2.75 IVMP non-responders/PLEX-responders vs 0.5 IVMP/PLEX non-responders;
p = 0.49) and had comparable outcomes to the IVMP-responders (nadir EDSS 8.0 to 5.25
[ΔEDSS = 2.75] vs nadir EDSS 6.5 to 5.0; [ΔEDSS = 1.5], respectively).
Conclusion
Add - on PLEX treatment in NMOSD patients with an acute attack should be considered
in those not responding to IVMP alone.
Keywords
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Article info
Publication history
Published online: January 17, 2018
Accepted:
January 12,
2018
Received in revised form:
December 30,
2017
Received:
November 28,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
