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

Plasma Exchange or Immunoadsorption in Demyelinating Diseases: A Meta-Analysis

Department of Nephrology and Rheumatology, University Medical Center Göttingen, Robert-Koch-Str. 40, D-37075 Goettingen, Germany
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(5), 1597;
Received: 11 May 2020 / Revised: 17 May 2020 / Accepted: 18 May 2020 / Published: 25 May 2020
(This article belongs to the Special Issue Apheresis in Neurological Disorders)
Multiple sclerosis (MS) is an inflammatory disease mainly affecting the central nervous system. In MS, abnormal immune mechanisms induce acute inflammation, demyelination, axonal loss, and the formation of central nervous system plaques. The long-term treatment involves options to modify the disease progression, whereas the treatment for the acute relapse has its focus in the administration of high-dose intravenous methylprednisolone (up to 1000 mg daily) over a period of three to five days as a first step. If symptoms of the acute relapse persist, it is defined as glucocorticosteroid-unresponsive, and immunomodulation by apheresis is recommended. However, several national and international guidelines have no uniform recommendations on using plasma exchange (PE) nor immunoadsorption (IA) in this case. A systematic review and meta-analysis was conducted, including observational studies or randomized controlled trials that investigated the effect of PE or IA on different courses of MS and neuromyelitis optica (NMO). One thousand, three hundred and eighty-three patients were included in the evaluation. Therapy response in relapsing-remitting MS and clinically isolated syndrome was 76.6% (95%CI 63.7–89.8%) in PE- and 80.6% (95%CI 69.3–91.8%) in IA-treated patients. Based on the recent literature, PE and IA may be considered as equal treatment possibilities in patients suffering from acute, glucocorticosteroid-unresponsive MS relapses. View Full-Text
Keywords: multiple sclerosis; plasma exchange; immunoadsorption multiple sclerosis; plasma exchange; immunoadsorption
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MDPI and ACS Style

Lipphardt, M.; Wallbach, M.; Koziolek, M.J. Plasma Exchange or Immunoadsorption in Demyelinating Diseases: A Meta-Analysis. J. Clin. Med. 2020, 9, 1597.

AMA Style

Lipphardt M, Wallbach M, Koziolek MJ. Plasma Exchange or Immunoadsorption in Demyelinating Diseases: A Meta-Analysis. Journal of Clinical Medicine. 2020; 9(5):1597.

Chicago/Turabian Style

Lipphardt, Mark, Manuel Wallbach, and Michael J. Koziolek. 2020. "Plasma Exchange or Immunoadsorption in Demyelinating Diseases: A Meta-Analysis" Journal of Clinical Medicine 9, no. 5: 1597.

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