Highlights
- •Added-on PLEX in steroid non-responder is commonly conducted for NMOSD attack.
- •A prospective study between IVMP added-on PLEX and simultaneous IVMP+PLEX was done.
- •Both methods, preferable simultaneous therapy, showed benefit in acute NMOSD attack.
- •Simultaneous IVMP+ PLEX therapy should be inspired in acute severe attack of NMOSD.
Abstract
Background
: Our previous retrospective study demonstrated that NMOSD patients with an acute
attack who did not respond to IVMP alone, however, showed further significant improvement
after treatment with PLEX at 6 month-follow-up.
Objective
: To compare the efficacy between treatments with intravenous methylprednisolone (IVMP)
with subsequent add-on plasma exchange (PLEX) and a combination of simultaneous IVMP
and PLEX in neuromyelitis optica spectrum disorders (NMOSD) patients with a severe
acute attack.
Method: We conducted a prospective, randomized, controlled, pilot study of the treatments
for a severe acute attack in NMOSD patients.
Results
: There were eleven AQP4-positive NMOSD patients in the study. One received only IVMP,
five received IVMP with subsequent add-on PLEX treatment, and the other five received
simultaneous IVMP and PLEX treatment. The attacks comprised myelitis (57.1%) and optic
neuritis (42.9%). Both treatments with IVMP followed by subsequent add-on PLEX when
needed (not-respond to IVMP treatment) and a combination treatment of simultaneous
IVMP+PLEX from the outset showed clinical improvement measured by EDSS at 6 months
follow-up, compared to those at the attacks (p-value = 0.07 in IVMP add-on PLEX group
and p-value = 0.05 in IVMP+PLEX group), respectively. Although, a trend of a better
outcome stratified by EDSS toward early PLEX initiation with IVMP+PLEX treatment was
observed at 6 months follow-up, however not significantly.
Conclusion
: Early treatment with PLEX should be encouraged especially in NMOSD with a severe
acute attack.
Keywords
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Article info
Publication history
Published online: November 05, 2019
Accepted:
November 4,
2019
Received in revised form:
October 27,
2019
Received:
May 1,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
