Plasma exchange therapy found effective for severe MS relapses
Outcomes better for patients younger, with low disability scores at relapse
Plasma exchange (PLEX) therapy is effective for severe relapses in people with multiple sclerosis (MS) who respond inadequately to standard corticosteroid therapy, according to a new study conducted in Serbia. Better outcomes were seen in younger patients and in those with low disability scores at the time of relapse.
PLEX, also known as plasmapheresis, eliminates MS-associated harmful substances from the blood by removing and replacing a person’s plasma, which is the liquid portion of blood. This procedure is performed in hospitals or specialized centers.
The study reporting the findings, titled “Beneficial therapeutic plasma exchange response in the treatment of severe relapses in patients with multiple sclerosis,” was published in the journal Acta Neurologica Belgica.
Although previous studies have demonstrated that PLEX is effective as a second-line treatment for severe MS relapses that are refractory to standard pulse treatment with corticosteroids, “predictors of PLEX response were not consistent,” the researchers wrote.
To gain more insights into the therapy’s efficacy and determine “the clinical and demographic factors that could be potentially associated with the short-term and long-term PLEX outcome,” a team of researchers in Serbia analyzed data from MS patients with severe and corticosteroid-refractory relapses who were treated at the Neurology Clinic, University Clinical Centre of Serbia, from 2007 until 2020.
Study analyzed data from 107 MS patients, 127 severe relapses
In total, data from 107 MS patients who experienced 127 severe relapses were analyzed. Of these, 14 patients experienced more than one severe relapse. The majority of the group had relapsing-remitting MS (83.2%), with smaller proportions having secondary progressive MS (12.1%) and primary progressive MS (4.7%).
The average patient age was 39.2 years, with a higher female-to-male ratio (2.3 to 1). The mean expanded disability status scale (EDSS) score of the patient group before PLEX was 3, ranging between 0 and 8 (the higher the EDSS score, the worse the level of MS disability). At the time of a severe relapse, 43 patients (34.1%) were receiving disease-modifying treatments (DMTs).
Patients waited a median of 32 days from relapse onset to receiving PLEX therapy, and a median of 20 days between steroid treatment and PLEX. One relapse was not treated with corticosteroids before PLEX.
Patients underwent five to seven PLEX sessions over 14 to 21 days. Clinical outcomes were assessed by comparing the EDSS before and after treatment, with a follow-up at six months.
The researchers found 73.8% of severe MS relapses showed marked clinical improvement after PLEX, 7.1% showed mild improvement, and 19.0% had no improvement (no beneficial effect with PLEX). The median EDSS score significantly decreased from 6.0 (when relapse symptoms were at their most severe, indicating a high level of disability) to 4.0 by the time patients were discharged from the clinic. This improvement was sustained at the six-month follow-up.
Younger age, lower disability score during relapse predict better PLEX response
When comparing patients with any improvement against patients with no improvement after PLEX — and taking into account several variables that could influence the outcomes (referred to as a multivariate analysis) — the data showed that a younger age and lower EDSS score during relapse were predictors of a better PLEX response
Previous DMT use or time between relapse onset and treatment administration did not affect PLEX response.
Adverse events occurred in 22 cases (17.3%), including hypofibrinogenemia (lower-than-normal blood levels of fibrinogen, an important blood clotting factor), hypotension (low blood pressure), and fainting, but all were resolved with appropriate treatment.
“In conclusion, this study confirmed high effectiveness and safety of PLEX in the severe and steroid refractory MS relapses,” the researchers wrote, adding “it seems crucial to start PLEX, as soon as possible in cases of steroid resistant severe relapses.”
According to the team, limitations of the study include the fact it was conducted at a single center and did not include a comparison to a group not treated with PLEX.
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