Table 3. Overview of publications on therapeutic plasma exchange in acute neuromyelitis optica relapse.
| Author | Year | Journal | Study design | NMO patients | Relevant results | Ref. |
|---|---|---|---|---|---|---|
| Keegan et al. | 2002 | Neurology | Retrospective | 10 | Marked to moderate improvement in 60% of the patients. Early initiation of therapy was associated with greater improvement. | 16 |
| Watanabe et al. | 2007 | Multiple Sclerosis Journal | Retrospective | 6 | Moderate improvement in 50% of the patients unresponsive to IVMP. The clinical improvement started to appear after one or two exchanges. | 34 |
| Bonnan et al. | 2009 | Multiple Sclerosis Journal | Retrospective | 34 | Residual EDSS and lowering of EDSS scores were significantly better in the PLEX-treated group than in the group treated only with IVMP. | 5 |
| Llufriu et al. | 2009 | Neurology | Retrospective | 4 | Improvement in 75% NMOSD patients in 6 months. Early initiation of PLEX was a predictor of a good response. | 3 |
| Magaña et al. | 2011 | Archives of Neurology | Retrospective | 26 | Marked to moderate improvement in 42% of the patients. A shorter disease course was associated with a favorable PLEX outcome. | 6 |
| Kim et al. | 2013 | Journal of Clinical Neurology | Retrospective | 15 | PLEX following IVMP therapy led to significant improvement in 50% of the attacks after the procedure and in 78% after 6 months. | 27 |
| Kleiter et al. | 2016 | Annals of Neurology | Retrospective | 186 | First-line therapy with PLEX was superior to IVMP in attacks involving the spinal cord. | 29 |
| Abboud et al. | 2016 | Multiple Sclerosis Journal | Retrospective | 59 | 65% of patients using IVMP concurrently with PLEX achieved an EDSS score ≤ their baseline against 35% in IVMP-only patients. | 35 |
| Aungsumart and Apiwattanakul . | 2017 | Multiple Sclerosis and Related Disorders | Retrospective | 24 | PLEX following IVMP therapy led to a significant improvement in 81% of the cases after 6 months of follow-up. | 39 |
| Kleiter et al. | 2018 | Neurology: Neuroimmunology & NeuroInflammation | Retrospective | 105 | A strong predictor of complete remission was the use of PLEX as a first-line therapy. Immediate start within 2 days of symptom onset was associated with greater degree of recovery. | 47 |
| Jiao et al. | 2018 | Clinical Therapeutics | Retrospective | 29 | Improvement in 82.8% of the patients at 1 month after PLEX. Early PLEX initiation was an independent prognostic factor. | 33 |
| Kumar et al. | 2018 | Annals of Indian Academy of Neurology | Retrospective | 5 | Marked to moderate improvement in 60% of severely disabled IVMP-refractory patients. | 37 |
| Bonnan et al. | 2018 | Journal of Neurology, Neurosurgery, and Psychiatry | Retrospective | 55 | Early initiation of PLEX (≤ 5 days) was more beneficial than delayed PLEX. The study suggests a better outcome if PLEX is started before day 2 of the relapse. | 40 |
| Srisupa-Olan et al. | 2018 | Multiple Sclerosis and Related Disorders | Retrospective | 52 | IVMP non-responders but PLEX responders showed continuous and maximum improvement at 6 months follow-up. Patients who received PLEX had a significantly lower relapse rate compared with those who received IVMP alone. | 42 |
| Kumawat et al. | 2019 | Annals of Indian Academy of Neurology | Retrospective | 30 | Improvement in 73.3% of the patients following PLEX. The only predictor of a good outcome was early initiation of therapy. | 36 |
| Songthammawat et al. | 2020 | Multiple Sclerosis and Related Disorders | Prospective, randomized | 11 | A trend towards a better outcome with early PLEX initiation and with IVMP and PLEX combined. | 46 |
| Palacios-Mendoza et al. | 2020 | Neurological Sciences | Retrospective | 15 | Improvement in 46.7% of the patients at discharge and in 70% after 6 months. | 38 |
| Kosiyakul et al. | 2020 | Annals of Clinical and Transnational Neurology | Meta-analysis | 241 | All studies consistently demonstrated the benefit of PLEX with improved visual acuity and decreasing EDSS scores. | 41 |
| Huang et al. | 2021 | Multiple Sclerosis and Related Disorders | Meta-analysis | 228 | The initiation time of PLEX significantly reduced the EDSS score in NMO patients and the optimal timing for PLEX was 8 to 23 days after the onset of the disease. | 44 |
| Yu et al. | 2020 | Journal of Neuroimmunology | Meta-analysis | 528 | PLEX treatment as a recue therapy resulted in a reduction in the mean EDSS score of 1.7, with a response rate of 75%. As a first-line therapy, PLEX resulted in a reduction in the mean EDSS score of 2.3, with a response rate of 71%. | 31 |
Abbreviations: EDSS, Expanded Disability Status Scale; IVMP, intravenous methylprednisolone; MS, multiple sclerosis; NMO, neuromyelitis optica; NMOSD, neuromyelitis optica spectrum disorders; PLEX, plasma exchange; Ref., reference.