Pinto Ashwin A, De Seze Jerome, Jacob Anu, Reddel Stephen, Yudina Anna, Tan Kevin
Department of Neurology, Wessex Neurological Centre, Southampton General Hospital, Southampton SO16 6YD, UK.
Department of Neurology, CHU Strasbourg, Strasbourg, France.
Ther Adv Neurol Disord. 2023 Mar 29;16:17562864231154306. doi: 10.1177/17562864231154306. eCollection 2023.
Intravenous immunoglobulin (IVIg) and therapeutic plasma exchange (TPE) are among the main immunotherapies for neurological disorders. Their benefit is greatest in immune-mediated conditions, but their distinct efficacy cannot be simply explained.
This review aimed to systematically identify studies comparing the efficacy of TPE and IVIg treatments for selected autoimmune neurological disorders and identify optimal therapies for each condition.
PubMed, MEDLINE and Embase databases were searched for original publications from 1990 to 2021. Additional publications were identified expert recommendations. Conference abstracts older than 2017, review articles and articles without information on TPE and IVIg comparison in title and abstract were excluded. Risks of bias were descriptively addressed, without a meta-analysis.
Forty-four studies were included on Guillain-Barré syndrome (20 studies - 12 adult, 5 paediatric, 3 all ages), myasthenia gravis (11 studies -8 adult, 3 paediatric), chronic immune-mediated polyradiculoneuropathy (3 studies -1 adult, 2 paediatric), encephalitis (1 study in adults), neuromyelitis optica spectrum disorders (5 studies -2 adult, 3 all ages) and other conditions (4 studies - all ages). TPE and IVIg were mostly similarly efficacious, measured by clinical outcomes and disease severity scores. Some studies recommended IVIg as easy to administer. TPE procedures, however, have been simplified and the safety has been improved. TPE is currently recommended for management of neuromyelitis optica spectrum disorder relapses and some myasthenia gravis subtypes, in which rapid removal of autoantibodies is crucial.
Despite some limitations (e.g. the low evidence levels), this review provides an extensive 30-year-long overview of treatments for various conditions. Both IVIg and TPE are usually comparably efficacious options for autoimmune neurological disorders, with few exceptions. Treatment choices should be patient-tailored and based on available clinical resources. Better designed studies are needed to provide higher-level quality of evidence regarding clinical efficacy of TPE and IVIg treatments.
静脉注射免疫球蛋白（IVIg）和治疗性血浆置换（TPE）是治疗神经系统疾病的主要免疫疗法。它们在免疫介导的疾病中疗效最佳，但其独特疗效难以简单解释。
本综述旨在系统识别比较TPE和IVIg治疗特定自身免疫性神经系统疾病疗效的研究，并确定每种疾病的最佳治疗方法。
检索了PubMed、MEDLINE和Embase数据库中1990年至2021年的原始出版物。通过专家推荐确定了其他出版物。排除2017年以前的会议摘要、综述文章以及标题和摘要中没有TPE与IVIg比较信息的文章。对偏倚风险进行了描述性分析，未进行荟萃分析。
纳入了44项关于吉兰-巴雷综合征（20项研究——12项针对成人，5项针对儿童，3项针对各年龄段）、重症肌无力（11项研究——8项针对成人，3项针对儿童）、慢性免疫介导性多发性神经根神经病（3项研究——1项针对成人，2项针对儿童）、脑炎（1项成人研究）、视神经脊髓炎谱系障碍（5项研究——2项针对成人，3项针对各年龄段）和其他疾病（4项研究——针对各年龄段）的研究。以临床结局和疾病严重程度评分衡量，TPE和IVIg大多疗效相似。一些研究推荐IVIg，因其易于给药。然而，TPE程序已得到简化，安全性也有所提高。目前推荐TPE用于治疗视神经脊髓炎谱系障碍复发和某些重症肌无力亚型，在这些疾病中快速清除自身抗体至关重要。
尽管存在一些局限性（如证据水平较低），本综述提供了长达30年的各种疾病治疗的广泛概述。IVIg和TPE通常都是自身免疫性神经系统疾病的等效有效选择，少数情况除外。治疗选择应根据患者情况量身定制，并基于可用的临床资源。需要设计更优的研究，以提供关于TPE和IVIg治疗临床疗效的更高质量证据。
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