Cargando…

Treatment of the First Acute Relapse Following Therapeutic Plasma Exchange in Formerly Glucocorticosteroid-Unresponsive Multiple Sclerosis Patients—A Multicenter Study to Evaluate Glucocorticosteroid Responsiveness

Therapeutic options to treat multiple sclerosis (MS) relapses comprise glucocorticosteroids (GCS) as first-line and therapeutic plasma exchange (TPE) as second-line treatments in GCS-unresponsive patients. No guidelines exist for the treatment of another relapse following TPE. We retrospectively ana...

Descripción completa

Detalles Bibliográficos
Autores principales: Ehler, Johannes, Blechinger, Stephan, Rommer, Paulus S., Koball, Sebastian, Mitzner, Steffen, Hartung, Hans-Peter, Leutmezer, Fritz, Sauer, Martin, Zettl, Uwe K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5578139/
https://www.ncbi.nlm.nih.gov/pubmed/28800066
http://dx.doi.org/10.3390/ijms18081749
_version_ 1783260478367072256
author Ehler, Johannes
Blechinger, Stephan
Rommer, Paulus S.
Koball, Sebastian
Mitzner, Steffen
Hartung, Hans-Peter
Leutmezer, Fritz
Sauer, Martin
Zettl, Uwe K.
author_facet Ehler, Johannes
Blechinger, Stephan
Rommer, Paulus S.
Koball, Sebastian
Mitzner, Steffen
Hartung, Hans-Peter
Leutmezer, Fritz
Sauer, Martin
Zettl, Uwe K.
author_sort Ehler, Johannes
collection PubMed
description Therapeutic options to treat multiple sclerosis (MS) relapses comprise glucocorticosteroids (GCS) as first-line and therapeutic plasma exchange (TPE) as second-line treatments in GCS-unresponsive patients. No guidelines exist for the treatment of another relapse following TPE. We retrospectively analyzed the responsiveness to GCS in a subsequent relapse following TPE in previously GCS-unresponsive MS patients. Thirty-seven patients with GCS-unresponsive MS relapses received TPE (relapse A). All patients developed another relapse after the completion of TPE and received GCS again (relapse B). The primary study endpoint was the clinical response to GCS and TPE. Marked improvement was defined as clinically significant improvement in function, moderate improvement as a definite change of symptoms without significant impact on function, no effect comprised unchanged symptoms, and deterioration a worsening of symptoms or new deficits. The secondary endpoint was an improvement in expanded disability status scale (EDSS) scoring. All patients were GCS-unresponsive during relapse A and received TPE. During GCS treatment of relapse B, marked improvement was observed in 10, moderate improvement in 24, and no effect in three patients. The EDSS decreased in 15 patients. GCS might remain the first-line relapse treatment following TPE in formerly GCS-unresponsive MS patients.
format Online
Article
Text
id pubmed-5578139
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-55781392017-09-05 Treatment of the First Acute Relapse Following Therapeutic Plasma Exchange in Formerly Glucocorticosteroid-Unresponsive Multiple Sclerosis Patients—A Multicenter Study to Evaluate Glucocorticosteroid Responsiveness Ehler, Johannes Blechinger, Stephan Rommer, Paulus S. Koball, Sebastian Mitzner, Steffen Hartung, Hans-Peter Leutmezer, Fritz Sauer, Martin Zettl, Uwe K. Int J Mol Sci Article Therapeutic options to treat multiple sclerosis (MS) relapses comprise glucocorticosteroids (GCS) as first-line and therapeutic plasma exchange (TPE) as second-line treatments in GCS-unresponsive patients. No guidelines exist for the treatment of another relapse following TPE. We retrospectively analyzed the responsiveness to GCS in a subsequent relapse following TPE in previously GCS-unresponsive MS patients. Thirty-seven patients with GCS-unresponsive MS relapses received TPE (relapse A). All patients developed another relapse after the completion of TPE and received GCS again (relapse B). The primary study endpoint was the clinical response to GCS and TPE. Marked improvement was defined as clinically significant improvement in function, moderate improvement as a definite change of symptoms without significant impact on function, no effect comprised unchanged symptoms, and deterioration a worsening of symptoms or new deficits. The secondary endpoint was an improvement in expanded disability status scale (EDSS) scoring. All patients were GCS-unresponsive during relapse A and received TPE. During GCS treatment of relapse B, marked improvement was observed in 10, moderate improvement in 24, and no effect in three patients. The EDSS decreased in 15 patients. GCS might remain the first-line relapse treatment following TPE in formerly GCS-unresponsive MS patients. MDPI 2017-08-11 /pmc/articles/PMC5578139/ /pubmed/28800066 http://dx.doi.org/10.3390/ijms18081749 Text en © 2017 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ehler, Johannes
Blechinger, Stephan
Rommer, Paulus S.
Koball, Sebastian
Mitzner, Steffen
Hartung, Hans-Peter
Leutmezer, Fritz
Sauer, Martin
Zettl, Uwe K.
Treatment of the First Acute Relapse Following Therapeutic Plasma Exchange in Formerly Glucocorticosteroid-Unresponsive Multiple Sclerosis Patients—A Multicenter Study to Evaluate Glucocorticosteroid Responsiveness
title Treatment of the First Acute Relapse Following Therapeutic Plasma Exchange in Formerly Glucocorticosteroid-Unresponsive Multiple Sclerosis Patients—A Multicenter Study to Evaluate Glucocorticosteroid Responsiveness
title_full Treatment of the First Acute Relapse Following Therapeutic Plasma Exchange in Formerly Glucocorticosteroid-Unresponsive Multiple Sclerosis Patients—A Multicenter Study to Evaluate Glucocorticosteroid Responsiveness
title_fullStr Treatment of the First Acute Relapse Following Therapeutic Plasma Exchange in Formerly Glucocorticosteroid-Unresponsive Multiple Sclerosis Patients—A Multicenter Study to Evaluate Glucocorticosteroid Responsiveness
title_full_unstemmed Treatment of the First Acute Relapse Following Therapeutic Plasma Exchange in Formerly Glucocorticosteroid-Unresponsive Multiple Sclerosis Patients—A Multicenter Study to Evaluate Glucocorticosteroid Responsiveness
title_short Treatment of the First Acute Relapse Following Therapeutic Plasma Exchange in Formerly Glucocorticosteroid-Unresponsive Multiple Sclerosis Patients—A Multicenter Study to Evaluate Glucocorticosteroid Responsiveness
title_sort treatment of the first acute relapse following therapeutic plasma exchange in formerly glucocorticosteroid-unresponsive multiple sclerosis patients—a multicenter study to evaluate glucocorticosteroid responsiveness
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5578139/
https://www.ncbi.nlm.nih.gov/pubmed/28800066
http://dx.doi.org/10.3390/ijms18081749
work_keys_str_mv AT ehlerjohannes treatmentofthefirstacuterelapsefollowingtherapeuticplasmaexchangeinformerlyglucocorticosteroidunresponsivemultiplesclerosispatientsamulticenterstudytoevaluateglucocorticosteroidresponsiveness
AT blechingerstephan treatmentofthefirstacuterelapsefollowingtherapeuticplasmaexchangeinformerlyglucocorticosteroidunresponsivemultiplesclerosispatientsamulticenterstudytoevaluateglucocorticosteroidresponsiveness
AT rommerpauluss treatmentofthefirstacuterelapsefollowingtherapeuticplasmaexchangeinformerlyglucocorticosteroidunresponsivemultiplesclerosispatientsamulticenterstudytoevaluateglucocorticosteroidresponsiveness
AT koballsebastian treatmentofthefirstacuterelapsefollowingtherapeuticplasmaexchangeinformerlyglucocorticosteroidunresponsivemultiplesclerosispatientsamulticenterstudytoevaluateglucocorticosteroidresponsiveness
AT mitznersteffen treatmentofthefirstacuterelapsefollowingtherapeuticplasmaexchangeinformerlyglucocorticosteroidunresponsivemultiplesclerosispatientsamulticenterstudytoevaluateglucocorticosteroidresponsiveness
AT hartunghanspeter treatmentofthefirstacuterelapsefollowingtherapeuticplasmaexchangeinformerlyglucocorticosteroidunresponsivemultiplesclerosispatientsamulticenterstudytoevaluateglucocorticosteroidresponsiveness
AT leutmezerfritz treatmentofthefirstacuterelapsefollowingtherapeuticplasmaexchangeinformerlyglucocorticosteroidunresponsivemultiplesclerosispatientsamulticenterstudytoevaluateglucocorticosteroidresponsiveness
AT sauermartin treatmentofthefirstacuterelapsefollowingtherapeuticplasmaexchangeinformerlyglucocorticosteroidunresponsivemultiplesclerosispatientsamulticenterstudytoevaluateglucocorticosteroidresponsiveness
AT zettluwek treatmentofthefirstacuterelapsefollowingtherapeuticplasmaexchangeinformerlyglucocorticosteroidunresponsivemultiplesclerosispatientsamulticenterstudytoevaluateglucocorticosteroidresponsiveness