Tayanan Srisupa-Olan1, Sasitorn Siritho2, Kulvara Kittisares3, Jiraporn Jitprapaikulsan4, Chanjira Sathukitchai5, Naraporn Prayoonwiwat6. 1. Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. Electronic address: tayanans@gmail.com. 2. Division of Neurology, Department of Medicine, Bumrungrad International Hospital, Bangkok 10110, Thailand. Electronic address: siritho@yahoo.com. 3. Division of Transfusion Medicine, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. Electronic address: kulvara@gmail.com. 4. Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. Electronic address: jiraporn.jit@mahidol.ac.th. 5. Bangkok Hospital Headquarters, BDMS, Bangkok 10310, Thailand. Electronic address: medchan@gmail.com. 6. Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. Electronic address: naraporn.pra@mahidol.ac.th.
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.
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.
Authors: C Restrepo-Aristizábal; L M Giraldo; Y M Giraldo; A M Pino-Pérez; F Álvarez-Gómez; C A Franco; J V Tobón; J L Ascencio; M I Zuluaga Journal: Heliyon Date: 2021-04-17