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Response to Therapeutic Plasma Exchange as a Rescue Treatment in Clinically Isolated Syndromes and Acute Worsening of Multiple Sclerosis: A Retrospective Analysis of 90 Patients.

Ehler J, Koball S, Sauer M, Mitzner S, Hickstein H, Benecke R, Zettl UK - PLoS ONE (2015)

Bottom Line: The median EDSS was reduced from 3.75 before to 3.0 after TPE (p = 0.001).In the multiple logistic regression analysis only the detection of Gd+ MRI lesions was significantly altered (p = 0.004).Gd+ MRI lesions before treatment were the best predictor of the response to TPE in our cohort.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology and Intensive Care Medicine, University of Rostock, Rostock, Germany; Department of Neurology, Neuroimmunology Section, University of Rostock, Rostock, Germany.

ABSTRACT

Objectives: Experience with therapeutic plasma exchange (TPE) for acute relapses in clinically isolated syndrome (CIS) or multiple sclerosis (MS) patients has been derived from small and inhomogeneous patient populations so far. In the present study, we retrospectively evaluated features associated with TPE response in a larger cohort of CIS and MS patients with acute worsening of disease.

Participants: Ninety CIS and MS patients with acute relapses or acute worsening of symptoms were firstly treated with TPE. The population consisted of 62 women and 28 men with a median age of 38 years (range 18-69 years).

Outcome measures: Primary endpoint was the clinical response to TPE, focused on the functional improvement of the target neurologic deficit. Secondary endpoint was an improvement in expanded disability status scale (EDSS) scoring.

Results: A clinical response to TPE was observed in 65 out of 90 patients (72.2%), with marked improvement in 18 (20.0%) and moderate improvement in 47 out of 90 patients (52.2%). The median EDSS was reduced from 3.75 before to 3.0 after TPE (p = 0.001). Response to TPE was significantly more frequent in patients with relapsing courses of disease (CIS, RR-MS, p = 0.001), no disease modifying drugs (p = 0.017), gadolinium-positive (Gd+) MRI lesions (p = 0.001) and EDSS ≤ 5.0 before TPE (p = 0.014). In the multiple logistic regression analysis only the detection of Gd+ MRI lesions was significantly altered (p = 0.004).

Conclusion: Clinical response to TPE was achieved in the majority of our patients. We identified clinical and diagnostic features in CIS and MS relapses that might be helpful to identify patients responding to TPE. Gd+ MRI lesions before treatment were the best predictor of the response to TPE in our cohort.

No MeSH data available.


Related in: MedlinePlus

Glucocorticosteroid treatment and therapeutic plasma exchange in clinically isolated syndrome and multiple sclerosis patients.A) Response to glucocorticosteroid treatment in CIS and MS patients (n = 81). B) Response to therapeutic plasma exchange in CIS and MS patients (n = 90). C) Different responses to therapeutic plasma exchange in CIS and MS patients (n = 90). D) Development of median EDSS values during therapeutic plasma exchange (n = 90). CIS = clinically isolated syndrome, Deterioration = clinical symptom worsened and/or additional symptoms, Insufficient improvement = slight change in symptom without impact on function, Marked improvement = clinically significant improvement in function, Moderate improvement = definite change of the neurologic deficit without significant impact on function within the functional score, MS = multiple sclerosis, n = number of patients, No effect = clinical symptom unchanged, PP-MS = primary-progressive MS with acute worsening, RR-MS = relapsing-remitting MS, SP-MS = secondary-progressive MS with superimposed relapse, * p = 0.01 (CIS versus SP-MS), ** p = 0.002 (RR-MS versus SP-MS), *** p = 0.001 (EDSS before versus after TPE).
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pone.0134583.g001: Glucocorticosteroid treatment and therapeutic plasma exchange in clinically isolated syndrome and multiple sclerosis patients.A) Response to glucocorticosteroid treatment in CIS and MS patients (n = 81). B) Response to therapeutic plasma exchange in CIS and MS patients (n = 90). C) Different responses to therapeutic plasma exchange in CIS and MS patients (n = 90). D) Development of median EDSS values during therapeutic plasma exchange (n = 90). CIS = clinically isolated syndrome, Deterioration = clinical symptom worsened and/or additional symptoms, Insufficient improvement = slight change in symptom without impact on function, Marked improvement = clinically significant improvement in function, Moderate improvement = definite change of the neurologic deficit without significant impact on function within the functional score, MS = multiple sclerosis, n = number of patients, No effect = clinical symptom unchanged, PP-MS = primary-progressive MS with acute worsening, RR-MS = relapsing-remitting MS, SP-MS = secondary-progressive MS with superimposed relapse, * p = 0.01 (CIS versus SP-MS), ** p = 0.002 (RR-MS versus SP-MS), *** p = 0.001 (EDSS before versus after TPE).

Mentions: Eighty-one out of 90 patients received a high dose GCS treatment prior to TPE (Fig 1A). In 9 out of 90 patients, GCS were not administered to treat the acute relapse due to documented GCS-non-response during previous relapse treatment (n = 4) and due to known severe adverse events (steroid-induced pancreatitis, femoral head osteonecrosis with fracture) against GCS (n = 2). In three patients with an intermittent GCS treatment (1g MP given daily over 5 days every 3 months) the new clinical attack was evaluated as GCS-unresponsive and these patients immediately received TPE.


Response to Therapeutic Plasma Exchange as a Rescue Treatment in Clinically Isolated Syndromes and Acute Worsening of Multiple Sclerosis: A Retrospective Analysis of 90 Patients.

Ehler J, Koball S, Sauer M, Mitzner S, Hickstein H, Benecke R, Zettl UK - PLoS ONE (2015)

Glucocorticosteroid treatment and therapeutic plasma exchange in clinically isolated syndrome and multiple sclerosis patients.A) Response to glucocorticosteroid treatment in CIS and MS patients (n = 81). B) Response to therapeutic plasma exchange in CIS and MS patients (n = 90). C) Different responses to therapeutic plasma exchange in CIS and MS patients (n = 90). D) Development of median EDSS values during therapeutic plasma exchange (n = 90). CIS = clinically isolated syndrome, Deterioration = clinical symptom worsened and/or additional symptoms, Insufficient improvement = slight change in symptom without impact on function, Marked improvement = clinically significant improvement in function, Moderate improvement = definite change of the neurologic deficit without significant impact on function within the functional score, MS = multiple sclerosis, n = number of patients, No effect = clinical symptom unchanged, PP-MS = primary-progressive MS with acute worsening, RR-MS = relapsing-remitting MS, SP-MS = secondary-progressive MS with superimposed relapse, * p = 0.01 (CIS versus SP-MS), ** p = 0.002 (RR-MS versus SP-MS), *** p = 0.001 (EDSS before versus after TPE).
© Copyright Policy
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4526633&req=5

pone.0134583.g001: Glucocorticosteroid treatment and therapeutic plasma exchange in clinically isolated syndrome and multiple sclerosis patients.A) Response to glucocorticosteroid treatment in CIS and MS patients (n = 81). B) Response to therapeutic plasma exchange in CIS and MS patients (n = 90). C) Different responses to therapeutic plasma exchange in CIS and MS patients (n = 90). D) Development of median EDSS values during therapeutic plasma exchange (n = 90). CIS = clinically isolated syndrome, Deterioration = clinical symptom worsened and/or additional symptoms, Insufficient improvement = slight change in symptom without impact on function, Marked improvement = clinically significant improvement in function, Moderate improvement = definite change of the neurologic deficit without significant impact on function within the functional score, MS = multiple sclerosis, n = number of patients, No effect = clinical symptom unchanged, PP-MS = primary-progressive MS with acute worsening, RR-MS = relapsing-remitting MS, SP-MS = secondary-progressive MS with superimposed relapse, * p = 0.01 (CIS versus SP-MS), ** p = 0.002 (RR-MS versus SP-MS), *** p = 0.001 (EDSS before versus after TPE).
Mentions: Eighty-one out of 90 patients received a high dose GCS treatment prior to TPE (Fig 1A). In 9 out of 90 patients, GCS were not administered to treat the acute relapse due to documented GCS-non-response during previous relapse treatment (n = 4) and due to known severe adverse events (steroid-induced pancreatitis, femoral head osteonecrosis with fracture) against GCS (n = 2). In three patients with an intermittent GCS treatment (1g MP given daily over 5 days every 3 months) the new clinical attack was evaluated as GCS-unresponsive and these patients immediately received TPE.

Bottom Line: The median EDSS was reduced from 3.75 before to 3.0 after TPE (p = 0.001).In the multiple logistic regression analysis only the detection of Gd+ MRI lesions was significantly altered (p = 0.004).Gd+ MRI lesions before treatment were the best predictor of the response to TPE in our cohort.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology and Intensive Care Medicine, University of Rostock, Rostock, Germany; Department of Neurology, Neuroimmunology Section, University of Rostock, Rostock, Germany.

ABSTRACT

Objectives: Experience with therapeutic plasma exchange (TPE) for acute relapses in clinically isolated syndrome (CIS) or multiple sclerosis (MS) patients has been derived from small and inhomogeneous patient populations so far. In the present study, we retrospectively evaluated features associated with TPE response in a larger cohort of CIS and MS patients with acute worsening of disease.

Participants: Ninety CIS and MS patients with acute relapses or acute worsening of symptoms were firstly treated with TPE. The population consisted of 62 women and 28 men with a median age of 38 years (range 18-69 years).

Outcome measures: Primary endpoint was the clinical response to TPE, focused on the functional improvement of the target neurologic deficit. Secondary endpoint was an improvement in expanded disability status scale (EDSS) scoring.

Results: A clinical response to TPE was observed in 65 out of 90 patients (72.2%), with marked improvement in 18 (20.0%) and moderate improvement in 47 out of 90 patients (52.2%). The median EDSS was reduced from 3.75 before to 3.0 after TPE (p = 0.001). Response to TPE was significantly more frequent in patients with relapsing courses of disease (CIS, RR-MS, p = 0.001), no disease modifying drugs (p = 0.017), gadolinium-positive (Gd+) MRI lesions (p = 0.001) and EDSS ≤ 5.0 before TPE (p = 0.014). In the multiple logistic regression analysis only the detection of Gd+ MRI lesions was significantly altered (p = 0.004).

Conclusion: Clinical response to TPE was achieved in the majority of our patients. We identified clinical and diagnostic features in CIS and MS relapses that might be helpful to identify patients responding to TPE. Gd+ MRI lesions before treatment were the best predictor of the response to TPE in our cohort.

No MeSH data available.


Related in: MedlinePlus