Escalation Therapy of Steroid Refractory Multiple Sclerosis Relapse with Tryptophan Immunoadsorption - Observational Multicenter Study with 147 Patients.
A marked proportion of multiple sclerosis (MS) relapses is followed by incomplete recovery. Our aim was to considerably increase the evidence of the clinical use of immunoadsorption (IA) as escalation therapy for patients with MS relapse.



A retrospective multicenter study was performed in MS patients with steroid refractory relapse who were treated with tryptophan IA. The main outcome parameter was change of acute relapse-related disability assessed by Expanded Disability Status Scale (EDSS) and visual acuity (VA) measurements for patients with optic neuritis (ON). IA treatments were performed using single-use tryptophan adsorbers.



Data of 147 MS patients and 786 single IA treatments were analyzed. Treatment with IA was commenced in mean 32 ± 35 days after the onset of relapse. One hundred and five out of 147 patients (71.4%) improved functionally after mean 5.4 IA treatments within 7-10 days. EDSS improved from median 5 (interquartile range, IQR 3.5) to 4 (IQR 2.5) (p < 0.001). In patients with ON (n = 32), VA improved after the IA series in 84% of cases from median 0.2 (IQR 0.6) to 0.6 (IQR 0.66) (p < 0.001). In 98.9% of IA treatments, no clinically relevant side effect was reported.



Tryptophan IA was found to be effective and well tolerated as escalation therapy for MS relapse.
Department of Neurology, General Hospital Lx00FC;denscheid, Lx00FC;denscheid, Germany.
Sebastian
S
Schimrigk
Jürgen
J
Faiss
Wolfgang
W
Köhler
Albrecht
A
Günther
Lutz
L
Harms
Andrea
A
Kraft
Sven
S
Ehrlich
Axel
A
Eberl
Cordula
C
Fassbender
Reinhard
R
Klingel
Jan
J
Galle
Arne
A
Riedlinger
Frank
F
Hoffmann
D000328:Adult; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007163:Immunosorbent Techniques; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000628:therapy*; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D014364:Tryptophan; D055815:Young Adult
D013256:Steroids; D014364:Tryptophan