Treatment of acute relapses in neuromyelitis optica: Steroids alone versus steroids plus plasma exchange.
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.
Department of Neurology, Cleveland Clinic, USA/Department of Neurology, University of Alexandria, Egypt abboudh@ccf.org.
Hesham
H
Abboud
Department of Neuroscience, Ohio State University, USA.
Alex
A
Petrak
Department of Neurology, Johns Hopkins University, USA.
Maureen
M
Mealy
Department of Neurology, Johns Hopkins University, USA.
Sarana
S
Sasidharan
Department of Neurology, Johns Hopkins University, USA.
Laila
L
Siddique
Department of Neurology, Johns Hopkins University, USA.
Michael
M
Levy
D000208:Acute Disease; D061605:Administration, Intravenous; D000328:Adult; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000628:therapy*; D010951:Plasma Exchange / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D005938:Glucocorticoids; D008775:Methylprednisolone
EDSS; Neuromyelitis optica; acute relapse; plasma exchange; preventive medications; steroids