A closer look at plasmapheresis in multiple sclerosis: the cons.

Plasmapheresis has been associated with clinical benefit in autoimmune disorders such as Guillain-Barré syndrome and myasthenia gravis, and this has generated interest in its use in patients with multiple sclerosis (MS). However, clinical trials of plasmapheresis in MS have shown little or no benefit from this intervention. The rationale for using plasmapheresis is the removal of an autoimmune antibody from the circulation. However, this approach relies on the assumption that a pathologic autoantibody is present in the vascular compartment and is in transit to the CNS to sites of MS plaques. In addition, for plasmapheresis to be an expedient therapy, it is essential that the target organ recover its biologic function rapidly following removal of circulating autoantibody. Our own study results and the findings of others have indicated that the cost-benefit ratio of plasmapheresis does not favor its use in patients with MS, alone or in combination with other immunosuppressive therapy. Very little sustained clinical benefit attributable to plasmapheresis has been observed.