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Therapeutic Apheresis in Acute Relapsing Multiple Sclerosis: Current Evidence and Unmet Needs—A Systematic Review
Open AccessArticle

Comparing Plasma Exchange to Escalated Methyl Prednisolone in Refractory Multiple Sclerosis Relapses

1
Neurology Clinic and Institute for Translational Neurology, University of Muenster, 48149 Münster, Germany
2
Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Münster, Germany
3
Department of Internal Medicine D, University of Muenster 48149 Münster, Germany
4
Department of Neurology, University Duisburg-Essen, 45147 Essen, Germany
*
Author to whom correspondence should be addressed.
Both authors contributed equally.
J. Clin. Med. 2020, 9(1), 35; https://doi.org/10.3390/jcm9010035
Received: 3 December 2019 / Revised: 16 December 2019 / Accepted: 18 December 2019 / Published: 22 December 2019
(This article belongs to the Special Issue Apheresis in Neurological Disorders)
Intravenous methyl prednisolone (IVMPS) represents the standard of care for multiple sclerosis (MS) relapses, but fail to improve symptoms in one quarter of patients. In this regard, apart from extending steroid treatment to a higher dose, therapeutic plasma exchange (TPE) has been recognized as a treatment option. The aim of this retrospective, monocentric study was to investigate the efficacy of TPE versus escalated dosages of IVMPS in refractory MS relapses. An in-depth medical chart review was performed to identify patients from local databases. Relapse recovery was stratified as “good/full”, “average” and “worst/no” according to function score development. In total, 145 patients were analyzed. Good/average/worst recovery at discharge was observed in 60.9%/32.6%/6.5% of TPE versus 15.2%/14.1%/70.7% of IVMPS patients, respectively. A total of 53.5% of IVMPS patients received TPE as rescue treatment and 54.8% then responded satisfactorily. The multivariable odds ratio (OR) for worst/no recovery was 39.01 (95%–CI: 10.41–146.18; p ≤ 0.001), favoring administration of TPE as first escalation treatment. The effects were sustained at three-month follow-ups, as OR for further deterioration was 6.48 (95%–CI: 2.48–16.89; p ≤ 0.001), favoring TPE. In conclusion, TPE was superior over IVMPS in the amelioration of relapse symptoms at discharge and follow-up. This study provides class IV evidence supporting the administration of TPE as the first escalation treatment to steroid-refractory MS relapses. View Full-Text
Keywords: multiple sclerosis; optic neuritis; plasma exchange; relapse; class IV; steroids multiple sclerosis; optic neuritis; plasma exchange; relapse; class IV; steroids
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MDPI and ACS Style

Pfeuffer, S.; Rolfes, L.; Bormann, E.; Sauerland, C.; Ruck, T.; Schilling, M.; Melzer, N.; Brand, M.; Pul, R.; Kleinschnitz, C.; Wiendl, H.; Meuth, S.G. Comparing Plasma Exchange to Escalated Methyl Prednisolone in Refractory Multiple Sclerosis Relapses. J. Clin. Med. 2020, 9, 35. https://doi.org/10.3390/jcm9010035

AMA Style

Pfeuffer S, Rolfes L, Bormann E, Sauerland C, Ruck T, Schilling M, Melzer N, Brand M, Pul R, Kleinschnitz C, Wiendl H, Meuth SG. Comparing Plasma Exchange to Escalated Methyl Prednisolone in Refractory Multiple Sclerosis Relapses. Journal of Clinical Medicine. 2020; 9(1):35. https://doi.org/10.3390/jcm9010035

Chicago/Turabian Style

Pfeuffer, Steffen; Rolfes, Leoni; Bormann, Eike; Sauerland, Cristina; Ruck, Tobias; Schilling, Matthias; Melzer, Nico; Brand, Marcus; Pul, Refik; Kleinschnitz, Christoph; Wiendl, Heinz; Meuth, Sven G. 2020. "Comparing Plasma Exchange to Escalated Methyl Prednisolone in Refractory Multiple Sclerosis Relapses" J. Clin. Med. 9, no. 1: 35. https://doi.org/10.3390/jcm9010035

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