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Comparing Plasma Exchange to Escalated Methyl Prednisolone in Refractory Multiple Sclerosis Relapses

Intravenous methyl prednisolone (IVMPS) represents the standard of care for multiple sclerosis (MS) relapses, but fail to improve symptoms in one quarter of patients. In this regard, apart from extending steroid treatment to a higher dose, therapeutic plasma exchange (TPE) has been recognized as a t...

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Autores principales: Pfeuffer, Steffen, Rolfes, Leoni, Bormann, Eike, Sauerland, Cristina, Ruck, Tobias, Schilling, Matthias, Melzer, Nico, Brand, Marcus, Pul, Refik, Kleinschnitz, Christoph, Wiendl, Heinz, Meuth, Sven G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027010/
https://www.ncbi.nlm.nih.gov/pubmed/31877873
http://dx.doi.org/10.3390/jcm9010035
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author Pfeuffer, Steffen
Rolfes, Leoni
Bormann, Eike
Sauerland, Cristina
Ruck, Tobias
Schilling, Matthias
Melzer, Nico
Brand, Marcus
Pul, Refik
Kleinschnitz, Christoph
Wiendl, Heinz
Meuth, Sven G.
author_facet Pfeuffer, Steffen
Rolfes, Leoni
Bormann, Eike
Sauerland, Cristina
Ruck, Tobias
Schilling, Matthias
Melzer, Nico
Brand, Marcus
Pul, Refik
Kleinschnitz, Christoph
Wiendl, Heinz
Meuth, Sven G.
author_sort Pfeuffer, Steffen
collection PubMed
description Intravenous methyl prednisolone (IVMPS) represents the standard of care for multiple sclerosis (MS) relapses, but fail to improve symptoms in one quarter of patients. In this regard, apart from extending steroid treatment to a higher dose, therapeutic plasma exchange (TPE) has been recognized as a treatment option. The aim of this retrospective, monocentric study was to investigate the efficacy of TPE versus escalated dosages of IVMPS in refractory MS relapses. An in-depth medical chart review was performed to identify patients from local databases. Relapse recovery was stratified as “good/full”, “average” and “worst/no” according to function score development. In total, 145 patients were analyzed. Good/average/worst recovery at discharge was observed in 60.9%/32.6%/6.5% of TPE versus 15.2%/14.1%/70.7% of IVMPS patients, respectively. A total of 53.5% of IVMPS patients received TPE as rescue treatment and 54.8% then responded satisfactorily. The multivariable odds ratio (OR) for worst/no recovery was 39.01 (95%–CI: 10.41–146.18; p ≤ 0.001), favoring administration of TPE as first escalation treatment. The effects were sustained at three-month follow-ups, as OR for further deterioration was 6.48 (95%–CI: 2.48–16.89; p ≤ 0.001), favoring TPE. In conclusion, TPE was superior over IVMPS in the amelioration of relapse symptoms at discharge and follow-up. This study provides class IV evidence supporting the administration of TPE as the first escalation treatment to steroid-refractory MS relapses.
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spelling pubmed-70270102020-03-11 Comparing Plasma Exchange to Escalated Methyl Prednisolone in Refractory Multiple Sclerosis Relapses Pfeuffer, Steffen Rolfes, Leoni Bormann, Eike Sauerland, Cristina Ruck, Tobias Schilling, Matthias Melzer, Nico Brand, Marcus Pul, Refik Kleinschnitz, Christoph Wiendl, Heinz Meuth, Sven G. J Clin Med Article Intravenous methyl prednisolone (IVMPS) represents the standard of care for multiple sclerosis (MS) relapses, but fail to improve symptoms in one quarter of patients. In this regard, apart from extending steroid treatment to a higher dose, therapeutic plasma exchange (TPE) has been recognized as a treatment option. The aim of this retrospective, monocentric study was to investigate the efficacy of TPE versus escalated dosages of IVMPS in refractory MS relapses. An in-depth medical chart review was performed to identify patients from local databases. Relapse recovery was stratified as “good/full”, “average” and “worst/no” according to function score development. In total, 145 patients were analyzed. Good/average/worst recovery at discharge was observed in 60.9%/32.6%/6.5% of TPE versus 15.2%/14.1%/70.7% of IVMPS patients, respectively. A total of 53.5% of IVMPS patients received TPE as rescue treatment and 54.8% then responded satisfactorily. The multivariable odds ratio (OR) for worst/no recovery was 39.01 (95%–CI: 10.41–146.18; p ≤ 0.001), favoring administration of TPE as first escalation treatment. The effects were sustained at three-month follow-ups, as OR for further deterioration was 6.48 (95%–CI: 2.48–16.89; p ≤ 0.001), favoring TPE. In conclusion, TPE was superior over IVMPS in the amelioration of relapse symptoms at discharge and follow-up. This study provides class IV evidence supporting the administration of TPE as the first escalation treatment to steroid-refractory MS relapses. MDPI 2019-12-22 /pmc/articles/PMC7027010/ /pubmed/31877873 http://dx.doi.org/10.3390/jcm9010035 Text en © 2019 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
Pfeuffer, Steffen
Rolfes, Leoni
Bormann, Eike
Sauerland, Cristina
Ruck, Tobias
Schilling, Matthias
Melzer, Nico
Brand, Marcus
Pul, Refik
Kleinschnitz, Christoph
Wiendl, Heinz
Meuth, Sven G.
Comparing Plasma Exchange to Escalated Methyl Prednisolone in Refractory Multiple Sclerosis Relapses
title Comparing Plasma Exchange to Escalated Methyl Prednisolone in Refractory Multiple Sclerosis Relapses
title_full Comparing Plasma Exchange to Escalated Methyl Prednisolone in Refractory Multiple Sclerosis Relapses
title_fullStr Comparing Plasma Exchange to Escalated Methyl Prednisolone in Refractory Multiple Sclerosis Relapses
title_full_unstemmed Comparing Plasma Exchange to Escalated Methyl Prednisolone in Refractory Multiple Sclerosis Relapses
title_short Comparing Plasma Exchange to Escalated Methyl Prednisolone in Refractory Multiple Sclerosis Relapses
title_sort comparing plasma exchange to escalated methyl prednisolone in refractory multiple sclerosis relapses
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027010/
https://www.ncbi.nlm.nih.gov/pubmed/31877873
http://dx.doi.org/10.3390/jcm9010035
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