Decreased EDSS after plasma exchange in NMOSD

In a large cohort of patients with relapsing neuromyelitis optica spectrum disorders (NMOSD), treatment with steroids and plasma exchange was accompanied by a significant decrease in Expanded Disability Status Scale (EDSS). The benefit of plasma exchange correlated with the number of cycles received and was independent of the underlying clinical syndrome.

NMOSD are a group of inflammatory disorders of the CNS characterised by episodes of humoral-mediated inflammation. In concordance with the humoral pathogenesis, plasma exchange has proven to be a beneficial therapy in patients with severe NMOSD attacks [1]. The mechanism of action of plasma exchange involves the removal of different molecules that contribute to relapses of NMOSD, such as autoantibodies, complement proteins, and immune complexes.

In an observational, retrospective study presented by Dr Enrique Gómez-Figueroa (National Institute of Neurology and Neurosurgery, Mexico), all NMOSD patients who were treated with plasma exchange on top of standard methylprednisolone at the institute between 2010-2019 were included [2]. A total of 89 patients (78.7% female) were identified; mean age at onset was 38 years. Clinical syndrome was optic neuritis in 22.4%, longitudinally extensive myelitis in 28.1%, short transverse myelitis in 12.4%, and brainstem syndrome in 3.4% of patients.

The mean time from symptomatic onset to starting plasma exchange was 21 days. After a mean number of 5 plasma exchanges, a significant decrease was noted in median EDSS (6.5 to 6.0; P<0.001). The benefit of plasma exchange was irrespective of the clinical NMOSD disorder.

1. Srisupa-Olan T, et al. Mult Scler Relat Disord. 2018 Feb;20:115-121.
2. Gomez-Figueroa E, et al. Therapeutic Plasma Exchange Effect on Neuromyelitis Optica Spectrum Disorder. ECF 28^th Annual Meeting. Abstract 58.

Posted on 16 December 202016 February 2024