Thanapon Songthammawat1, Tayanan Srisupa-Olan2, Sasitorn Siritho3, Kulvara Kittisares4, Jiraporn Jitprapaikulsan5, Chanjira Sathukitchai6, Naraporn Prayoonwiwat7. 1. Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand. 2. Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand; Medicine Department, Nan Hospital, Nan, 55000, Thailand. 3. Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand; Division of Neurology, Department of Medicine, Bumrungrad International Hospital, Bangkok, 10110, Thailand. Electronic address: siritho@yahoo.com. 4. Division of Transfusion Medicine, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand. 5. Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand. Electronic address: jiraporn.jit@mahidol.ac.th. 6. Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand; Bangkok Hospital Headquarters, BDMS, Bangkok, 10310, Thailand. 7. 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: 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.
RCT Entities:
BACKGROUND: Our previous retrospective study demonstrated that NMOSDpatients 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 NMOSDpatients. RESULTS: There were eleven AQP4-positive NMOSDpatients 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.
Authors: Rohit Bhatia; M V Padma Srivastava; Dheeraj Khurana; Lekha Pandit; Thomas Mathew; Salil Gupta; M Netravathi; Sruthi S Nair; Gagandeep Singh; Bhim S Singhal Journal: Ann Indian Acad Neurol Date: 2020-04-13 Impact factor: 1.383