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Treatment of acute relapses in neuromyelitis optica: Steroids alone versus steroids plus plasma exchange.
Mult Scler 2016; 22(2):185-92MS

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.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25921047

Citation

Abboud, Hesham, et al. "Treatment of Acute Relapses in Neuromyelitis Optica: Steroids Alone Versus Steroids Plus Plasma Exchange." Multiple Sclerosis (Houndmills, Basingstoke, England), vol. 22, no. 2, 2016, pp. 185-92.
Abboud H, Petrak A, Mealy M, et al. Treatment of acute relapses in neuromyelitis optica: Steroids alone versus steroids plus plasma exchange. Mult Scler. 2016;22(2):185-92.
Abboud, H., Petrak, A., Mealy, M., Sasidharan, S., Siddique, L., & Levy, M. (2016). Treatment of acute relapses in neuromyelitis optica: Steroids alone versus steroids plus plasma exchange. Multiple Sclerosis (Houndmills, Basingstoke, England), 22(2), pp. 185-92. doi:10.1177/1352458515581438.
Abboud H, et al. Treatment of Acute Relapses in Neuromyelitis Optica: Steroids Alone Versus Steroids Plus Plasma Exchange. Mult Scler. 2016;22(2):185-92. PubMed PMID: 25921047.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of acute relapses in neuromyelitis optica: Steroids alone versus steroids plus plasma exchange. AU - Abboud,Hesham, AU - Petrak,Alex, AU - Mealy,Maureen, AU - Sasidharan,Sarana, AU - Siddique,Laila, AU - Levy,Michael, Y1 - 2015/04/28/ PY - 2014/11/20/received PY - 2015/03/15/accepted PY - 2015/4/30/entrez PY - 2015/4/30/pubmed PY - 2017/1/11/medline KW - EDSS KW - Neuromyelitis optica KW - acute relapse KW - plasma exchange KW - preventive medications KW - steroids SP - 185 EP - 92 JF - Multiple sclerosis (Houndmills, Basingstoke, England) JO - Mult. Scler. VL - 22 IS - 2 N2 - 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. SN - 1477-0970 UR - https://www.unboundmedicine.com/medline/citation/25921047/Treatment_of_acute_relapses_in_neuromyelitis_optica:_Steroids_alone_versus_steroids_plus_plasma_exchange_ L2 - http://journals.sagepub.com/doi/full/10.1177/1352458515581438?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -