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Mult Scler. 2016 Feb;22(2):185-92. doi: 10.1177/1352458515581438. Epub 2015 Apr 28.

Treatment of acute relapses in neuromyelitis optica: Steroids alone versus steroids plus plasma exchange.

Author information

1
Department of Neurology, Cleveland Clinic, USA/Department of Neurology, University of Alexandria, Egypt abboudh@ccf.org.
2
Department of Neuroscience, Ohio State University, USA.
3
Department of Neurology, Johns Hopkins University, USA.

Abstract

BACKGROUND:

Although adding plasma exchange (PLEX) to steroids in severe neuromyelitis optica (NMO) attacks is common practice in steroid-resistant cases, the benefit of this strategy has not been previously quantified.

OBJECTIVE:

The objective of this paper is to compare the efficacy of high-dose intravenous methylprednisolone (IVMP) versus IVMP+PLEX in treatment of acute NMO relapses.

METHODS:

We conducted a retrospective review of the last 83 NMO admissions to the Johns Hopkins Hospital treated with IVMP alone versus IVMP+PLEX (for steroid-resistant cases). Extended Disability Status Scale (EDSS) score was calculated at baseline, at presentation, at discharge, and on follow-up.

RESULTS:

Eighteen NMO relapses (16 patients, 87% female, mean age at relapse: 33.9±23.8, median baseline EDSS 2.5) were treated with IVMP alone and 65 relapses (43 patients, 95% female, mean age at relapse: 43.8±15.7, median baseline EDSS 5.75) were treated with IVMP + PLEX. Sixty-five percent of IVMP + PLEX patients achieved an EDSS equal or below their baseline at follow-up while only 35% of the IVMP-only patients achieved their baseline EDSS on follow-up (odds ratio=3.36, 95% CI 1.0657 to 10.6004, p = 0.0386). PLEX was more effective in improving EDSS in patients on preventive immunosuppressive medications at time of relapse.

CONCLUSIONS:

PLEX+IVMP are more likely to improve EDSS after NMO relapses compared to IVMP alone, especially in patients taking preventive medications.

KEYWORDS:

EDSS; Neuromyelitis optica; acute relapse; plasma exchange; preventive medications; steroids

PMID:
25921047
PMCID:
PMC4795457
DOI:
10.1177/1352458515581438
[Indexed for MEDLINE]
Free PMC Article

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