Lipphardt Mark, Mühlhausen Johannes, Kitze Bernd, Heigl Franz, Mauch Erich, Helms Hans-Joachim, Müller Gerhard A, Koziolek Michael J
Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Germany.
Department of Neurology, Georg-August-University Göttingen, Germany.
J Clin Apher. 2019 Aug;34(4):381-391. doi: 10.1002/jca.21686. Epub 2019 Jan 30.
Plasma exchange (PE) and immunoadsorption (IA) are alternative treatments of steroid-refractory relapses of multiple sclerosis (MS) or neuromyelitis optica (NMO).
Adverse events and neurological follow-ups in 127 MS- (62 PE, 65 IA) and 13 NMO- (11 PE, 2 IA) patients were retrospectively analyzed. Response was defined by improvements in either expanded disability status scale (EDSS) by at least 1.0 or visual acuity (VA) to 0.5, confirmed after 3 and/or 6 months.
Hundred and forty patients were included in safety analysis, 102 patients provided sufficient neurological follow-up-data. There were no significant differences between IA and PE in side effects (3.9% vs 3.6%, P = .96) or response-rate (P = .65). Responders showed significant lower age (P = .02) and earlier apheresis-initiation (P = .01). Subgroup-analysis confirmed significant lower age in patients with relapsing-remitting MS (RRMS) /clinical isolated syndrome (CIS).
IA and PE seem equally safe and effective in steroid-resistant MS- or NMO-relapses. Early apheresis and low patient age are additional prognostic factors.
血浆置换（PE）和免疫吸附（IA）是治疗多发性硬化症（MS）或视神经脊髓炎（NMO）类固醇难治性复发的替代疗法。
对127例MS患者（62例行PE，65例行IA）和13例NMO患者（11例行PE，2例行IA）的不良事件和神经学随访进行回顾性分析。反应定义为扩展残疾状态量表（EDSS）至少改善1.0或视力（VA）改善至0.5，并在3个月和/或6个月后得到确认。
140例患者纳入安全性分析，102例患者提供了充分的神经学随访数据。IA和PE在副作用（3.9%对3.6%，P = 0.96）或反应率（P = 0.65）方面无显著差异。有反应者年龄显著更低（P = 0.02）且更早开始血液成分分离术（P = 0.01）。亚组分析证实复发缓解型MS（RRMS）/临床孤立综合征（CIS）患者年龄显著更低。
IA和PE在类固醇抵抗性MS或NMO复发中似乎同样安全有效。早期血液成分分离术和患者年龄低是额外的预后因素。
